Hoan Le, Cuong Nguyen Ngoc, My Thieu Thi Tra, Luu Doan Tien, Long Hoang, Hoa Tran Quoc, Hoang Nguyen, Hoan Nguyen Cong
Respiratory Department, Hanoi Medical University, Hanoi, Viet Nam.
Radiology Center, Hanoi Medical University Hospital, Hanoi, Viet Nam.
Radiol Case Rep. 2023 Jun 30;18(9):3199-3202. doi: 10.1016/j.radcr.2023.06.048. eCollection 2023 Sep.
Chyle leak is a rare and serious condition caused by damaged lymphatic vessels. It can occur after retroperitoneal surgery involving extensive lymphadenectomy for kidney cancer. Besides lymphatic channel damage, the obstruction of the thoracic duct worsens the leakage. Managing patients with thoracic duct obstruction and postsurgical chyle leakage is challenging due to limited data on how to handle this condition. In this case report, a 28-year-old female patient underwent left nephrectomy for left kidney cancer. Three days after the surgery, milky fluid drained from the left renal fossa. Conservative treatment failed, and further examination through magnetic resonance lymphangiography revealed the absence of the thoracic duct and contrast extravasation at the left renal fossa. Lymphangiography confirmed distal thoracic duct obstruction. The patient's condition was successfully managed by using thoracic duct stenting. This report contributes to the understanding that thoracic duct obstruction can lead to lymphatic collateral circulation within the abdomen, thereby increasing the risk of postoperative chylous leak.
乳糜漏是一种由淋巴管受损引起的罕见且严重的病症。它可发生在因肾癌进行广泛淋巴结清扫的腹膜后手术后。除了淋巴管损伤外，胸导管阻塞会使漏出情况恶化。由于关于如何处理这种病症的数据有限，管理患有胸导管阻塞和术后乳糜漏的患者具有挑战性。在本病例报告中，一名28岁女性患者因左肾癌接受了左肾切除术。术后三天，乳白色液体从左肾窝引流出来。保守治疗失败，通过磁共振淋巴管造影进一步检查发现胸导管缺失且左肾窝有造影剂外渗。淋巴管造影证实胸导管远端阻塞。通过使用胸导管支架成功地控制了患者的病情。本报告有助于理解胸导管阻塞可导致腹部内淋巴侧支循环，从而增加术后乳糜漏的风险。
