Medicina pulmonar y respiratoria

Chylothorax Secondary to Spontaneous Rupture of the Cisterna Chyli Treated with Lymphangiography

Abstract

David Zhang, Kohei Hashimoto, Dheeraj K. Rajan and Michael Augustine Ko

We report a case of idiopathic chylothorax refractory to surgical management, where the leak was due to a spontaneously ruptured cisterna chyli. Surgical management was unsuccessful, including a left-sided pleuroscopy/pleurodesis and a right-sided thoracic duct ligation. After a prolonged period of hospitalization, lymphangiography ultimately demonstrated the site of the chyle leak as a spontaneously disrupted cisterna chyli. Due to the degree of disruption, it was not amenable to cannulation and embolization. However, lipiodol injection was sufficient in itself to lead to resolution of the chylothorax. Lymphangiography is a useful modality that can be potentially therapeutic in persistent chylothorax.