Search Results (11)

We report the case of a 68-year-old man presenting with rapidly progressive left cervical swelling, sialorrhea, and dysphagia. Imaging revealed a cervical fluid collection extending into the anterior mediastinum, initially suggestive of descending mediastinitis. Broad-spectrum antibiotic therapy was initiated, and surgical drainage was planned. Intraoperative exploration, however, revealed opalescent, milky fluid consistent with chyle, leading to a revised diagnosis of spontaneous chylocervical collection associated with chylothorax. Cultures were negative, and biochemical analysis confirmed markedly elevated triglyceride levels. Conservative management with total parenteral nutrition and a nil per os regimen achieved rapid resolution. Lymphangiography demonstrated normal thoracic duct anatomy without leakage. The patient was discharged in good condition, and follow-up imaging showed complete recovery. This case highlights the diagnostic challenge of differentiating chylous from infectious mediastinal collections, particularly when clinical presentation mimics descending mediastinitis. Accurate intraoperative assessment and multidisciplinary management are essential to avoid unnecessary invasive procedures. Rare etiologies such as idiopathic chylothorax should be considered in atypical presentations of cervical and mediastinal fluid collections. Full article

Background: Chyle leakage is known to be a rare postoperative complication following liver transplantation (LT), and continuous leakage of large volumes of chyle can worsen prognosis. However, its mechanism is not fully understood, and no existing reports show the influence of chyle leakage after LT on blood concentration of the drug tacrolimus. Case presentation: A 43-year-old male with primary hepatocellular carcinoma (HCC), decompensated cirrhosis, and massive ascites underwent orthotopic liver transplantation (OLT). During active chyle leakage, his daily tacrolimus dose was escalated to 4.0 mg with concurrent administration of a CYP3A5 inhibitor, but blood concentrations remained subtherapeutic (1.7–2.5 ng/mL). Conservative treatments failed, so intraperitoneal injection of erythromycin (0.75 g) dissolved in 25% glucose solution (40 mL) was initiated on postoperative day (POD) 11, then administered every other day. After three treatments, chylous drainage reduced significantly, and tacrolimus concentrations abruptly increased to 14.7 ng/mL following a marked reduction in chylous drainage (to 800 mL/d on POD 13). Subsequent dose adjustments stabilized tacrolimus levels at 4.6–6.2 ng/mL with a daily dose of 2.0 mg. Conclusions: Intraperitoneal injection of erythromycin hypertonic solution may promote lymphatic fistula closure via chemical stimulation, though its efficacy requires further validation. Chyle leakage likely reduces tacrolimus blood concentration through multiple potential mechanisms. This case highlights the need for clinical attention to the association between chyle leakage and immunosuppressant concentrations, though further studies are required for validation. Full article

In human medicine, the 2025 International Society for the Study of Vascular Anomalies (ISSVA) classification distinguishes localized lymphatic malformations from systemic disorders referred to as complex lymphatic anomalies (CLAs), including generalized lymphatic anomaly (GLA) and central conducting lymphatic anomaly (CCLA). GLA is characterized by multifocal proliferation of dilated lymphatic channels infiltrating soft tissues and visceral organs, whereas CCLA involves structural or functional abnormalities of the central lymphatic pathways such as the thoracic duct commonly resulting in chylous effusion. Reports of systemic lymphatic disease in veterinary species are exceedingly rare. A five-month-old intact male domestic shorthair cat presented with progressive dyspnea and was diagnosed with chylothorax and chylous ascites. Computed tomography (CT) revealed contrast leakage from both the thoracic duct and aortic hiatus, along with diffuse subcutaneous edema, indicating a systemic lymphatic disorder. Histopathology demonstrated proliferative lymphatic channels within the subcutaneous tissues, consistent with GLA, while imaging findings suggested concurrent CCLA, supporting classification as an overlapping CLA phenotype. Despite medical and surgical interventions, the cat developed progressive edema and recurrent pleural effusion and ultimately died. This case demonstrates that cats can develop systemic lymphatic disorders analogous to human CLAs and highlights the diagnostic value of CT lymphangiography. Furthermore, it underscores the utility of applying the ISSVA classification to enhance comparative understanding of lymphatic diseases in veterinary medicine. Full article

Objective: The aim of this study was to propose a pathophysiological hypothesis for the occurrence of non-traumatic chylous effusions and Central Conducting Lymphatic Anomalies (CCLAs) related to lymphatic occlusion. Methods: We investigated the case of a 39-year-old woman managed at Nîmes University Hospital for chylous anasarca related to an endoluminal lymphatic occlusion. We then conducted a comprehensive review of the literature on CCLAs. Results: Lymphatic drainage is a dynamic process. Obstacles to lymphatic drainage via the thoracic duct can lead to chylous anasarca, depending on where the obstruction is. Lymphatic occlusion seems to be an explanation for certain CCLAs. Conclusions: Understanding CCLAs via the theory of lymph occlusion opens the way to new therapeutic options, but requires further investigation in order to personalize the patient’s treatment. Full article

Objectives: To investigate the diagnostic value of various lymphatic imaging techniques for thoracic duct (TD) outlet obstruction in patients with chylous leakage. Methods: A retrospective analysis was conducted on 23 patients with chylous leakage who were radiologically diagnosed with a TD outlet obstruction and underwent a TD exploration and reconstruction between January 2022 and February 2025. Non-enhanced magnetic resonance lymphangiography (MRL), ⁹⁹Tc^m-DX lymphoscintigraphy, and intranodal lymphangiography were employed to detect abnormalities in the central lymphatic vessels. The Receiver Operating Characteristic (ROC) curve was utilized to analyze the diagnostic performance of these imaging methods for TD outlet obstruction in lymphatic disorders. Results: Twenty-three patients (fifteen males and eight females) with chylous leakage were included in this study, with an average age of 59.78 ± 13.08 years. Non-enhanced MRL, ⁹⁹Tc^m-DX lymphoscintigraphy, and intranodal lymphangiography revealed TD outlet obstructions in 13, 17, and 18 patients, respectively. Twenty patients exhibited findings consistent with preoperative imaging during TD explorations; the intraoperative microscopic visualization demonstrated the difficulty of white chyle entering the bloodstream for these patients. The ROC curve analysis indicated that “at least two imaging modalities were positive” and had the highest Area Under the Curve (AUC) value (0.90); “intranodal lymphangiography” and “non-enhanced magnetic resonance lymphangiography” followed closely with respective AUC values of 0.76 and 0.73, and ⁹⁹Tc^m-DX lymphoscintigraphy exhibited a lower AUC value 0.63. Conclusions: The combined utilization of multimodal lymphatic imaging techniques demonstrated a high diagnostic accuracy in identifying TD outlet obstruction in patients with chylous leakage. Full article

Chylothorax is a rare complication occurring after cardio-thoracic surgical procedures. This condition presents challenges for diagnosis and treatment. Operative ductal ligation is the method of choice for relapsing or refractory cases, and it can be performed through the aid of IGC injection for the identification of chylous leakage. Our report presents the use of ICG fluorescence during VATS to successfully identify and treat a left-sided post-surgical chylothorax. The patient underwent a pulmonary wedge resection for a suspect malignant lesion and developed chylous leakage in the early postoperative period. On postoperative day 7, the patient underwent a revision thoracoscopy for hemostasis and thoracic duct ligation. ICG injections were performed through bilateral inguinal lymph nodes and approximately 15 min after we performed the re-thoracoscopy with effective identification and ligation of the chyle leakage. ICG fluorescence-guided VATS is a valuable and effective method for managing postoperative chylothorax, especially for left-sided leaks. Full article

The aim of this study was to retrospectively evaluate the long-term results of lymphatic interventions in adults with abdomino-thoracic lymphatic pathologies. Management of abdomino-thoracic chylous effusions in adults undergoing X-ray-lymphangiography with or without lymph-vessel embolization (LVE) from 2010–2018 was reviewed. Patients underwent lymphangiography alone when imaging showed normal findings or lymphatic obstruction without leakage or reflux; otherwise, LVE was performed (leakage, reflux, obstruction with leakage or reflux, lymphatic masses). Technical and clinical success, complications, and long-term outcomes were assessed. 78 patients (47 male, median age 56.3 years) were treated for chylous effusions (60.3% traumatic, 39.7% non-traumatic). Lymphangiography showed leakage (48.7%), reflux (14.1%), obstruction (28.2%), lymphatic masses (5.1%), and normal findings (3.8%). Embolization was performed in 49/78 (62.8%) cases. Overall, treatment was clinically successful in 74.4% (mean follow-up of 28 months), with significant differences between LVE and lymphangiography (91.8% vs. 44.8%; p < 0.001), traumatic and non-traumatic etiologies (89.4% vs. 51.6%; p < 0.001), and leakage locations (p = 0.003). The clinical success of LVE did not differ between leakage etiologies or locations. Complications occurred in 5 patients (2/5 needed treatment). Patients survived significantly longer after successful treatment (2679 vs. 927 days; p = 0.044) and without malignancy (3214 vs. 1550 days; p = 0.043). Lymphatic interventions are safe and effective. LVE should be attempted whenever feasible, as success is high (>90%). Successful intervention has a positive effect on patient survival. Full article

Chylous ascites is a rare form of ascites usually associated with cirrhosis, abdominal malignancies, surgeries or infections. We presented a case of chylous ascites after robotic laparoscopic prostatectomy (PLDN-RALP), in which the correct diagnosis was achieved by SPECT/CT lymphoscintigraphy. A 72-year-old male developed chylous ascites after surgery and underwent lymphoscintigraphy with radiolabeled albumin nanocolloids for the supplementary study of the lymph flow and to detect a possible site of leakage. The scintigraphic imaging demonstrated the abdominal effusion and lymph stasis in the left iliac region. The combination of planar imaging with SPECT/CT can resolve the assessment of chylous disorders. Full article

Horner’s syndrome (HS), caused by lesions of the 3-neuron oculosympathetic nerve pathway (ONP), includes the triad: blepharoptosis, miosis and anhidrosis (ipsilateral with ONP damage). Thyroid–related HS represents an unusual entity underling thyroid nodules/goiter/cancer–HS (T-HS), and post-thyroidectomy HS (Tx-HS). We aim to overview Tx-HS. This is a narrative review. We revised PubMed published, full-length, English papers from inception to November 2022. Additionally, we introduced data on post-thyroidectomy lymphocele/chylous leakage (Tx-L), and introduced a new pediatric case with both Tx-HS and Tx-L. Tx-HS: the level of statistical evidence varies from isolated case reports, studies analyzing the large panel of post-thyroidectomy complications reporting HS among the rarest side effects (as opposite to hypocalcemia), or different series of patients with HS due to various disorders, including T-HS/Tx-HS. Tx-HS is related to benign or malignant thyroid conditions, regardless the type of surgery. A pre-operatory rate of T-HS of 0.14%; a post-operatory rate of Tx-HS between 0.03% and 5% (mostly, 0.2%) are identified; a possible higher risk on endoscopic rather than open procedure is described. Incomplete HS forms, and pediatric onset are identified, too; the earliest identification is after 2 h since intervention. A progressive remission is expected in most cases within the first 2–6 months to one year. The management is mostly conservative; some used glucocorticoids and neurotrophic agents. One major pitfall is an additional contributor factor like a local compression due to post-operatory collections (hematoma, cysts, fistula, Tx-L) and their correction improves the outcome. The prognostic probably depends on the severity of cervical sympathetic chain (CSC) lesions: indirect, mild injury due to local compressive masses, intra-operatory damage of CSC like ischemia and stretching of CSC by the retractor associate HS recovery, while CSC section is irreversible. Other iatrogenic contributors to HS are: intra-operatory manipulation of parathyroid glands, thyroid microwave/radiofrequency ablation, and high-intensity focused ultrasound, and percutaneous ethanol injection into thyroid nodules. Tx-L, rarely reported (mostly <0.5%, except for a ratio of 8.3% in one study), correlates with extended surgery, especially lateral/central neck dissection, and the presence of congenitally—aberrant lymphatic duct; it is, also, described after endoscopic procedures and chest-breast approach; it starts within days after surgery. Typically low-fat diet (even fasting and parental nutrition) and tube drainage are useful (as part of conservative management); some used octreotide, local sealing solutions like hypertonic glucose, Viscum album extract, n-Butyl-2-cyanoacrylate. Re-intervention is required in severe cases due to the risk of lymphorrhoea and chylothorax. Early identification of Tx-HS and Tx-L improves the outcome. Some iatrogenic complications are inevitable and a multifactorial model of prediction is still required, also taking into consideration standardized operatory procedures, skillful intra-operatory manipulation, and close post-operatory follow-up of the patients, especially during modern era when thyroid surgery registered a massive progress allowing an early discharge of the patients. Full article

(1) Background: A high volume of chylous leakage (>1 L/day) is a potentially lethal complication after neck dissection. However, a strategic treatment for when the leakage progresses from high to massive (>4 L/day) is lacking. (2) Methods: The PubMed database was searched for articles on neck dissection–associated chylous leakage. Nine articles that included 14 cases with >1 L/day chylous leakage (CL) were analyzed. (3) Results: Of the nine patients with 1–4 L/day CL, three were successfully managed with conservative treatment, two with thoracic ductal ligation, three with ductal embolization, and one with local repair with a strap muscle flap. Of the remaining five cases with >4 L/day chylous leakage, three were successfully treated with the pectoralis major myocutaneous flap (PMMF) and one was successfully treated with thoracic ductal ligation and one case died. (4) Conclusions: In this review, when leakage was >4 L/day, the aforementioned interventions were ineffective, but applying the PMMF could rescue the intractable complication. We propose a strategic treatment for high (1–4 L/day) and massive (>4 L/day) chylous leakage. Full article

Chylothorax can be spontaneously healed by lymphangiography using lipiodol, but pulmonary or systemic embolization is a potential complication. We determined the efficacy of iopamidol for treating chylous leakage in an animal model. Twelve pigs were randomly divided into two groups. After inducing thoracic duct damage, pigs from groups A and B were injected with iopamidol and lipiodol, respectively. At 5, 10, and 30 min after damage induction, the drug effects were monitored by video-assisted thoracoscopy and lymphangiography. In vitro, chyle samples from the pigs were incubated with iopamidol and lipiodol. The damaged thoracic duct was harvested and examined using microscopy. In group A, four and two pigs did not show chylous leakage after 5 and 10 min, respectively. In group B, none showed chylous leakage after 5 min. Nevertheless, the p value was 0.46, and there was no statistically significant difference between groups A and B. In vitro, both iopamidol- and lipiodol-treated chyle samples adhered after 5 min and solidified at 30 min. Our findings confirmed that the damaged thoracic duct was clogged with an amorphous proteinaceous material (iopamidol). Therefore, iopamidol is potentially a new therapeutic agent for chylous leakage. Thoracic duct embolization failures or systemic embolization risks from lipiodol injection may be avoided by injecting iopamidol via the thoracic duct, and this warrants further investigation. Full article