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Objective:To investigate the feasibility and effect of retrograde thoracic duct approach via left venous angle in the treatment of chylothorax.Methods:From July 2019 to April 2021, the clinical data of 16 patients with chylothorax in Shanghai Pulmonary Hospital Tongji University were retrospectively collected. All patients underwent percutaneous inguinal lymphography, super selective retrograde thoracic duct catheterization was attempted via the left venous angle. Successful patients underwent direct thoracic ductography. After the position of the rupture was shown, the thoracic duct was embolized with microcoils and glue.Results:The inguinal lymphography of 16 patients was successful, and the end of thoracic ducts was identified. Retrograde thoracic duct catheterizations were successful in 10 patients, 6 cases showed contrast agent overflow in thoracic ductography, and the thoracic ducts were embolized using microcoils combined with glue. Chylothorax was improved in 16 patients, and 6 cases were completely cured. All patients had no serious complications.Conclusion:It is an effective and feasible method to treat chylothorax by retrograde thoracic ductography and embolization approach via left venous angle.
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Objective To evaluate the value of magnetic resonance thoracic ductography (MRTD)and magnetic resonance (MR) pelvic scanning in the chylous leakage of female reproductive system.Methods A retrospective evaluation of the imaging findings of MRTD and MR pelvic in 7 patients was performed,and compared with direct lymphangiography (DLG),lymphoscintigraphy and surgery.Results The rate of thoracic duct visualization in DLG was 71 .4% (5/7 ).The rate of venous angle visualization inlym-phoscintigraphy was 71.4% (5/7).The rate of thoracic duct visualization in MRTD was 100% (7/7).Except for 1 case withgeneral-ly normal findings,the remaining 6 cases showedobstruction of the thoracic duct in MRTD.Among those cases,bilateral drainage was found in 1 case,right thoracic ductwas seen in 1 case,multiple tortuous dilated lymphatic channelsaround the venous angle was detected in 4 cases,and multiple lymphangiomas was seen in 1 case.All of the 7 patients were conducted by surgery.6 cases were confirmed as obstruction of the thoracic duct.MRTD & MR pelvic found more multiple lymphangiomas lesions and detected 2 cases with bone abnormalities.Conclusion MRTD combined with MR pelvic could provide more comprehensive assessment of female re-productive system chylous leakage.It should be used as routine examination before operation.
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Objective To evaluate the applicative value of fiberoptic ductoscopy(FDS)in abnormal nipple discharge.Methods A total of 104 patients with nipple discharge were examined by fiberoptic ductoscopy(Germany Scholly Fiberoptic Gmbh 42.0500).The results were compared with postoperative pathological diagnosis.Results All the 104 cases were successfully diagnosed with FDS.The detectable rate for intraductal mass by ductoscopy is 94 %(49/52).The sensitivity and specificity of ductoscopy for mammary duct cancer is 50%(1/2)and 91%(43/47)respectively;the negative predictive value is 98%(43/44),positive predictive value is 20%(1/5),and accuracy is 90%(44/49).Five cases of papillomatosis were diagnosed by ductoscopy,in which 3 cases were consistent with postoperative pathological findings,therefore the diagnose accordance rate is 60%;the other 2 cases were proven to be multiple papilloma.Thirty-eight cases of papilloma were detected by ductoscopy and received lobectomy of bresat;55 cases of inflammatory duct disease did not receive any operation;and 3 cases(3%,3/104)were diagnosed papilloma by re-examination with ductoscopy due to persistent nipple discharge,and were confirmed after operation.Conclusions Fiberoptic ductoscopy is the first choice for examination of nipple discharge for its accuracy in finding pathogenic cause and locating lesion,and surgery can thereby be avoided for galactophoritis and mammarv duct ectasia patients.
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Objective To evaluate the use of ductography.Method A review of 51 patients with presenting complaints of nipple discharge from January 1998 to May 2000 was conducted. Pathology and ductograms were reviewed.Result Ductography had a definite value in the diagnosis of nipple discharge, the sensitiveity was 84.3%.Conclusion Ductography had value to locate and identify leisions, especially multiple leisions and leisions in the periphery of the breast, but it did not exclude pathology.