Soliman Sami, Khoury Joe, Kocharyan Hakob, Yeisley Christopher, Salloum Elias, Al-Roubaie Mustafa
College of Medicine, University of South Florida Morsani College of Medicine, Tampa, USA.
Interventional Radiology, Emory University School of Medicine, Atlanta, USA.
Cureus. 2025 May 24;17(5):e84754. doi: 10.7759/cureus.84754. eCollection 2025 May.
Chylothorax, the accumulation of chyle in the pleural space, is a potentially fatal condition that necessitates intervention. Options range from conservative treatment, such as dietary modifications and pharmacological therapy, to percutaneous and surgical interventions. This case describes a 56-year-old male status post-lung wedge resection who developed a high-output chylothorax. Initial management with octreotide and a low-fat diet was unsuccessful. A percutaneous lymphangiogram identified extravasation of contrast from a thoracic duct side-branch. Instead of traditional thoracic duct embolization (TDE), selective lymphatic duct embolization (SLDE) was performed to preserve the main thoracic duct. The patient had rapid symptom resolution and successful chest tube removal. The patient was discharged within two days, without recurrence of symptoms. While TDE is a common percutaneous approach, it carries the risk of complete thoracic duct occlusion. This can lead to lymphatic backflow and leaks. When a single branch of the thoracic duct is injured, SLDE offers a novel alternative to target that side-branch while maintaining thoracic duct integrity. Comparative studies suggest SLDE provides similar efficacy to TDE while reducing severe complications. More research is needed to establish the long-term risks versus benefits of SLDE. SLDE is a promising, minimally invasive intervention for high-output chylothorax. It offers a safer alternative to TDE when a side-branch injury exists. This case highlights its potential for improving patient outcomes with fewer complications.
乳糜胸是指乳糜在胸腔内积聚,是一种可能致命的疾病,需要进行干预。治疗方案从保守治疗,如饮食调整和药物治疗,到经皮和手术干预。本病例描述了一名56岁男性,在肺楔形切除术后发生了高输出量乳糜胸。最初使用奥曲肽和低脂饮食治疗未成功。经皮淋巴管造影显示造影剂从胸导管侧支外渗。未采用传统的胸导管栓塞术(TDE),而是进行了选择性淋巴管栓塞术(SLDE)以保留胸导管主干。患者症状迅速缓解,胸腔引流管成功拔除。患者在两天内出院,症状未复发。虽然TDE是一种常见的经皮治疗方法,但它有导致胸导管完全闭塞的风险。这可能导致淋巴回流和渗漏。当胸导管的单个分支受损时,SLDE提供了一种新的选择,可针对该侧支进行治疗,同时保持胸导管的完整性。比较研究表明,SLDE与TDE疗效相似,但严重并发症减少。需要更多的研究来确定SLDE的长期风险与益处。SLDE是一种有前景的、微创的高输出量乳糜胸干预方法。当存在侧支损伤时,它为TDE提供了一种更安全的替代方法。本病例突出了其在减少并发症的情况下改善患者预后的潜力。