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1.
J Vasc Interv Radiol ; 32(6): 896-900, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33689836

RESUMO

Chyluria is the leakage of intestinal lymph (chyle) into the urine. Novel lymphatic intervention techniques, such as interstitial lymphatic embolization, proved to be a useful treatment option for chyluria. However, one of the challenges of this approach is the difficulty in identifying connections between the lymphatic system and kidney collecting system. Here, embolization of the abnormal lymphatic connection through retrograde thoracic duct access in 3 chyluria patients is introduced.


Assuntos
Quilo , Embolização Terapêutica , Embucrilato/administração & dosagem , Doenças Linfáticas/terapia , Ducto Torácico , Adulto , Idoso , Quilo/diagnóstico por imagem , Feminino , Humanos , Doenças Linfáticas/diagnóstico por imagem , Doenças Linfáticas/urina , Linfografia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Ducto Torácico/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia de Intervenção
3.
J Vasc Interv Radiol ; 31(5): 795-800, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32359526

RESUMO

From 2015 to 2019, 9 patients underwent ultrasound-guided intranodal lymphangiography for the treatment of a chyle leak following thoracic outlet decompression surgery. Chyle leaks were identified by Lipiodol (Guerbet, Roissy, France) extravasation near the left supraclavicular surgical bed in all patients. The technical success rate of thoracic duct embolization was 67% (6 of 9), including fluoroscopic transabdominal antegrade access (n = 4) and ultrasound-guided retrograde access in the left neck (n = 2). Clinical success was achieved in 89% of patients (8 of 9). The mean interval from lymphangiography to drain removal was 6.6 days (range, 4-18 d). No patients had a chyle leak recurrence during clinical follow-up (mean, 304 d).


Assuntos
Quilo/diagnóstico por imagem , Descompressão Cirúrgica/efeitos adversos , Embolização Terapêutica , Linfografia , Ducto Torácico/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico/cirurgia , Adulto , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Ducto Torácico/lesões , Síndrome do Desfiladeiro Torácico/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
5.
Am J Otolaryngol ; 40(4): 598-600, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30979654

RESUMO

BACKGROUND: Cervical chylous fistulae are rare complications usually occurring from iatrogenic injury to the thoracic duct. There have been no reported cases of spontaneous chyle leaks in surgical naïve necks. METHODS: Case report. RESULTS: A 50 year-old female presented with progressive left neck swelling without fever, dyspnea, or dysphagia. Imaging demonstrated extensive infiltrative changes of the left neck with retropharyngeal fluid extending into strap musculature and the mediastinum. Flexible laryngoscopy revealed posterior pharyngeal wall edema. Differential diagnosis included abscess versus necrotizing fasciitis. Broad-spectrum antibiotics were initiated and she was taken to the OR for neck exploration. Intra-operatively, milky fluid was present around the carotid sheath and in the retropharyngeal space. Fluid analysis demonstrated chylomicrons and triglycerides >2400 mg/dL. Repeat imaging of the neck, chest, and abdomen did not reveal malignancy or obstructive masses. A lymphangiogram showed dilated lymphatic vessels near the cervical thoracic duct. On post-operative day four, the patient was taken back to the OR for thoracic duct ligation and biopsy of nearby tissue. Pathology demonstrated benign lymph nodes with dilated sinusoids. A low-fat diet was started and she was discharged home on hospital day nine. She has followed up regularly with no signs of recurrence. CONCLUSION: A cervical chylous fistula usually results from iatrogenic injury to the thoracic duct. To our knowledge, this is the first reported case of a spontaneous cervical chyle leak.


Assuntos
Quilo/diagnóstico por imagem , Fístula/diagnóstico , Fístula/cirurgia , Pescoço , Dieta com Restrição de Gorduras , Feminino , Fístula/patologia , Humanos , Ligadura , Linfonodos/patologia , Linfografia , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Ducto Torácico/diagnóstico por imagem , Ducto Torácico/cirurgia , Resultado do Tratamento
6.
Cardiovasc Intervent Radiol ; 41(12): 1968-1971, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30066092

RESUMO

Chyluria is characterized by the presence of chyle in the urine and often presents clinically as urinary obstruction. Traditional treatments include dietary modifications, surgery and sclerotherapy. The recently developed intranodal lymphangiography and dynamic contrast-enhanced MR lymphangiography (DCMRL) provide better imaging of the lymphatic system. Interstitial lymphatic embolization is a new interventional technique that allows delivery of n-butyl cyanoacrylate glue into the network of the lymphatic vessels. This report describes the demonstration of lympho-urinary tract communications using DCMRL and intranodal lymphangiography in three patients who presented with chyluria, and successful treatment of chyluria in two patients using interstitial lymphatic embolization.


Assuntos
Quilo/diagnóstico por imagem , Meios de Contraste , Embolização Terapêutica/métodos , Aumento da Imagem/métodos , Linfografia/métodos , Imageamento por Ressonância Magnética/métodos , Doenças Urológicas/diagnóstico por imagem , Adulto , Feminino , Humanos , Vasos Linfáticos/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Doenças Urológicas/terapia
8.
AJR Am J Roentgenol ; 210(4): 792-798, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29470154

RESUMO

OBJECTIVE: The objective of our study was to investigate the clinical value of diagnostic lymphangiography followed by sequential CT examinations in patients with idiopathic chyluria. MATERIALS AND METHODS: Thirty-six patients with idiopathic chyluria underwent unipedal diagnostic lymphangiography and then underwent sequential CT examinations. The examinations were reviewed separately by two radiologists. Abnormal distribution of contrast medium, lymphourinary leakages, and retrograde flow were noted, and the range and distribution of lymphatic vessel lesions were recorded. The stage of idiopathic chyluria based on CT findings and the stage based on clinical findings were compared. Therapeutic management and follow-up were recorded. Statistical analyses were performed. RESULTS: Compared with CT studies performed after lymphangiography, diagnostic lymphangiography showed a unique capability to depict lymphourinary leakages in three patients. Lymphourinary fistulas and abnormal dilated lymphatic vessels were found in and around kidney in all patients. CT depicted retrograde flow of lymph fluid in 47.2% of patients. The consistency in staging chyluria based on CT findings and clinical findings was fair (κ = 0.455). Twenty-nine patients underwent conservative therapy, and seven underwent surgery. Surgical therapy was superior to conservative management (no recurrence, 85.7% of patients who underwent surgery vs 62.1% of patients who underwent conservative therapy; p = 0.025). CONCLUSION: From assessing the drainage of contrast medium on unipedal diagnostic lymphangiography and the redistribution of contrast medium on sequential CT examinations, it is possible to detect the existence of lymphourinary fistulas, the precise location of lymphatic anomalies, the distribution of collateral lymphatic vessels, and hydrodynamic pressure abnormality in the lymph circulation in patients with idiopathic chyluria. CT staging of chyluria provides additional information that can be used to guide therapeutic management.


Assuntos
Quilo/diagnóstico por imagem , Linfografia/métodos , Tomografia Computadorizada por Raios X/métodos , Doenças Urológicas/diagnóstico por imagem , Adolescente , Adulto , Idoso , Criança , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
J Nucl Med Technol ; 46(2): 123-128, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29438003

RESUMO

In the pediatric setting, lymphoscintigraphy is used mostly for the evaluation of lymphedema. Only a few cases of chylous anomalies and lymphatic malformations imaged with lymphoscintigraphy have been reported in the literature. The aim of this study was to review the use of lymphoscintigraphy in those pathologies. Methods: All lymphoscintigraphy studies performed for chylous anomalies between 2001 and 2017 in our hospital were retrospectively reviewed. The results were correlated to clinical and radiologic findings. Lymphoscintigraphy consisted of sequential imaging after injection of 3.7-9.25 MBq (100-250 µCi) of 99mTc-filtered sulfur colloid at the level of the feet or hands. Results: Twenty-five studies were performed on 21 patients. Fourteen studies were obtained for the evaluation of chylothorax. Eleven were performed for chyloperitoneum, chyluria, chylopericardium, exudative enteropathy, or lymphangiomatosis. Ten studies were positive for lymphatic leakage, and 1 had uncertain results. After correlation with radiologic findings and follow-up, there were 7 true-negative and 5 false-negative results (previous 67Ga-interfering activity in 1, injection in only the hands in 3, and a low-fat diet in 1). One study became positive after injection in the feet, and another became positive after a switch to a high-fat diet. Conclusion: Lymphoscintigraphy is a useful tool for imaging lymphatic anomalies in children. Suggestions to optimize results include placing the patient on a high-fat diet, withholding octreotide, injecting the 4 extremities, and imaging with SPECT/CT.


Assuntos
Quilo/diagnóstico por imagem , Quilotórax/diagnóstico por imagem , Ascite Quilosa/diagnóstico por imagem , Linfangioma/diagnóstico por imagem , Linfocintigrafia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Urina
12.
Int Urol Nephrol ; 48(10): 1565-9, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27363980

RESUMO

PURPOSE: To compare the efficacy and safety of two approaches in retroperitoneoscopic renal pedicle lymphatic disconnection (RRPLD) for intractable chyluria: completely or partly mobilize the kidney. MATERIALS AND METHODS: Retrospectively reviewed the clinical data of 77 patients, who underwent RRPLD because of intractable chyluria in our institution. We mobilized the whole affected kidney in 22 patients during the operation, but only dissected the lower part in other 55 patients. Operative time, blood loss, visual analog scale (VAS) score, postoperative bed rest, postoperative hospital stay, recurrence, intraoperative and postoperative complications were compared between the two groups. RESULTS: All operation was successful, and none convert to open. The chyluria was resolved immediately after surgery. Compared with completely mobilized RRPLD (CMR), partly mobilized RRPLD (PMR) was superior in terms of operative time (132.91 ± 35.65 vs. 91.73 ± 24.14 min), blood loss (35.68 ± 8.21 vs. 25.09 ± 7.41 ml), VAS score (4.63 ± 0.44 vs. 2.34 ± 0.80), postoperative bed rest (3.36 ± 0.49 vs. 1.80 ± 0.85 days) and hospital stay (6.77 ± 1.57 vs. 4.98 ± 1.89 days). Compilations occurred in three patients in CMR group and two in PMR. Recurrence was confirmed by cystoscopy in three patients during 3-103-month follow-up, CMR group with 1 and PMR with 2. CONCLUSION: In our study, we found PMR was equally effective and safe as CMR. Moreover, it is more minimally invasive, painless and economical. Therefore, we believe it is unnecessary to completely mobilize the kidney in RRPLD for intractable chyluria.


Assuntos
Quilo/diagnóstico por imagem , Complicações Pós-Operatórias , Fístula Urinária , Doenças Urológicas/cirurgia , Procedimentos Cirúrgicos Urológicos , China , Feminino , Humanos , Rim/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Espaço Retroperitoneal , Resultado do Tratamento , Fístula Urinária/complicações , Fístula Urinária/diagnóstico por imagem , Fístula Urinária/cirurgia , Urina , Doenças Urológicas/diagnóstico , Doenças Urológicas/fisiopatologia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/métodos
13.
Head Neck ; 38(2): E54-60, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25995135

RESUMO

BACKGROUND: Chylous leakage is a well-recognized but rare complication of head and neck surgery, affecting approximately 1% to 2.5% of head and neck dissections. It is a potentially life-threatening condition characterized by electrolyte imbalance, immunosuppression, delayed wound healing, risk of infection, and generalized sepsis. Management can be problematic and prolonged. METHODS: We present a case of refractory cervical chylous leakage after neck dissection treated with ultrasound-guided intranodal lymphangiography. RESULTS: Ultrasound-guided intranodal lymphangiography alone resulted in rapid and complete resolution of chylous leakage with minimal morbidity. CONCLUSION: Based on our clinical experience and after a thorough literature review, we propose that ultrasound-guided intranodal lymphangiography with contrast agent could be considered a viable therapeutic option for persistent chylous leakages in selected patients.


Assuntos
Quilo/diagnóstico por imagem , Linfografia , Esvaziamento Cervical/efeitos adversos , Ducto Torácico/diagnóstico por imagem , Ultrassonografia de Intervenção , Meios de Contraste , Embolização Terapêutica , Óleo Etiodado , Humanos , Masculino , Pessoa de Meia-Idade
15.
Urol Int ; 94(2): 215-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25171183

RESUMO

OBJECTIVES: To evaluate the efficacy and safety of pedal lymphography (PLG) in the localization diagnosis of chyluria. METHODS: Cystoscopy was performed in 153 patients and PLG in 121 cases. Unilateral or staged bilateral ligation and stripping of renal lymphatic vessel were performed according to the results of cystoscopy and/or PLG. RESULTS: Unilateral and bilateral urinary excretion of chyle was detected in 123 and 1 case by cystoscopy, respectively. In 121 cases receiving PLG, 100 cases of unilateral fistulous connection between the renal pelvis and the lymphatic system, 18 cases of bilateral fistulas and 1 case of lymphatic bladder fistula were demonstrated. PLG has a higher diagnostic rate for the detection of bilateral lymphatic renal pelvis fistulas than cystoscopy (p<0.05). 28 cases received renal pedicle lymphatic disconnection only according to the results of cystoscopy, and 3 of them failed (10.1%). While 121 cases had the same operation according to the results of PLG, only 1 case failed the operation (0.8%). CONCLUSIONS: PLG was efficient and safe for the localization diagnosis of chyluria, with a higher detection rate of bilateral fistulas than cystoscopy. PLG might benefit the selection of appropriate therapy and improve the surgical effect.


Assuntos
Quilo/diagnóstico por imagem , Fístula/diagnóstico por imagem , Doenças Linfáticas/diagnóstico por imagem , Linfografia/métodos , Tomografia Computadorizada por Raios X , Adulto , Cistoscopia , Feminino , Fístula/terapia , Humanos , Doenças Linfáticas/terapia , Linfografia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios X/efeitos adversos , Resultado do Tratamento , Urina
16.
Clin Nucl Med ; 40(1): 41-4, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25310405

RESUMO

A 74-year-old woman underwent the radical near-total gastrectomy with Billroth II anastomosis and lymph nodes dissection due to the advanced gastric cancer. On the seventh day after gastrectomy, edema on the both legs and abdominal distention were developed. On the lymphoscintigraphy, the abnormal activity in the peritoneal cavity was revealed, and chyloperitoneum was diagnosed, and additional dynamic scans could localize the chyle leakage focus. Localization of chyle leakage focus enabled surgeon to establish the proper operative plan for the injured lymphatics.


Assuntos
Ascite Quilosa/diagnóstico por imagem , Gastrectomia/efeitos adversos , Linfocintigrafia , Neoplasias Gástricas/cirurgia , Idoso , Quilo/diagnóstico por imagem , Ascite Quilosa/etiologia , Feminino , Humanos , Neoplasias Gástricas/complicações
17.
Clin Nucl Med ; 39(8): 760-1, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24978330

RESUMO

Iatrogenic chyle leak with chyloma formation is a rare complication of kidney transplantation resulting from injury to the lymphatics. We present a case of a 53-year-old man who complained of right leg swelling 2 months after kidney transplantation for chronic renal failure. Abdomen CT showed loculated fluid collection around the transplanted kidney. Lymphoscintigraphy demonstrated chyle leak in the right iliac fossa, and subsequent ultrasound-guided aspiration of the chyloma showed radioactivity as detected by gamma camera. After drainage insertion, the amount of collected fluid gradually decreased, and right leg edema was relieved.


Assuntos
Quilo/diagnóstico por imagem , Edema/diagnóstico por imagem , Transplante de Rim/efeitos adversos , Linfocintigrafia , Abdome/diagnóstico por imagem , Edema/etiologia , Câmaras gama , Humanos , Perna (Membro)/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade
18.
Clin Nucl Med ; 39(5): 485-7, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24662670

RESUMO

Chylous reflux is described as the backflow of chyle through the varicose lymphatics with incompetent lymph valves and leakage of the lymph. The valves in the dilated, varicose, tortuous lymph vessels become incompetent, and as a result, the lymph blended with chyle, reflux into the lower limbs or the genitalia. Reflux causes delayed lymphatic transport in the affected lower extremity and chronic lymphedema can develop. Vesicles containing chyle could appear on the skin of the involved parts, and milky fluid discharge of the lymph and chyle interferes greatly with quality of life.


Assuntos
Quilo/diagnóstico por imagem , Linfocintigrafia , Adolescente , Humanos , Masculino , Tomografia Computadorizada por Raios X , Adulto Jovem
19.
Recenti Prog Med ; 103(11): 555-8, 2012 Nov.
Artigo em Italiano | MEDLINE | ID: mdl-23096753

RESUMO

Lymphoscintigraphy is a first-line imaging technique for the assessment of abnormal lymphatic drainage in chyluria. It can provide information about the site of origin of chyluria, and may be helpful in selecting patients for surgery and assessing treatment efficacy. We report the case of a 59-year-old male with chyluria correctly diagnosed with lymphoscintigraphy.


Assuntos
Quilo/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Cintilografia , Urina
20.
Clin Nucl Med ; 37(11): 1126-8, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23027206

RESUMO

Iatrogenic chyle leak with chyloma formation in the neck is a rare complication of neck dissection resulting from injury to the thoracic duct. We present the case of a 37-year-old woman who complained of left-sided neck swelling within days after total thyroidectomy and lateral neck dissection for papillary thyroid cancer. Lymphoscintigraphy demonstrated the chyle leak in the left cervical region, and subsequent aspiration of the left neck swelling showed radioactivity in the aspirate. After successful operative repair of the thoracic duct, the patient was able to undergo radioactive ablative thyroid treatment.


Assuntos
Quilo/diagnóstico por imagem , Doença Iatrogênica , Linfocintigrafia , Pescoço/diagnóstico por imagem , Adulto , Feminino , Humanos , Pescoço/cirurgia , Esvaziamento Cervical/efeitos adversos , Tireoidectomia/efeitos adversos
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