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Fig. 2 | European Radiology Experimental

Fig. 2

From: Percutaneous afferent lymphatic vessel sclerotherapy for postoperative lymphatic leakage after previous ineffective therapeutic transpedal lymphangiography

Fig. 2

Images from a patient who was diagnosed with erosive esophagitis-induced esophageal stenosis. a Contrast-enhanced CT showed an irregular thickness of the distal esophageal wall (white arrowheads). Then the thoracic-abdominal esophagus resection plus lymphadenectomy was performed. After the surgery, the right chylothorax appeared with the average daily output of 1,130 mL. b The two drainage catheters (white arrowheads) were also observed at the ideal locations in the chest radiogram. Due to the ineffective total parenteral nutrition with a high percentage of MCTs, TL was performed, and 15.0 mL of iodinated oil was injected. c Eight hours later, CT scan showed a definite rupture (white arrowhead) of the thoracic duct (white arrows) with the extravasation to the right pleural cavity. d The distal cisterna chyli (white hollow arrowhead) was regarded as the target afferent lymphatic vessel. Because of the gradual increase of the thoracic drainage after TL, ALVS was performed 3 days later as a salvage. e In the preoperative CT scan, a small amount of residual iodinated oil could still be seen at the cisterna chyli (white hollow arrowhead). f Then, the planned puncture was achieved, and the tip was close to the cisterna chyli. g Afterwards, 1 mL if contrast agent was injected and showed an ideal distribution around the cisterna chyli. After that, 4.0 mL 95% ethanol was injected. After the procedure, the chylothorax output gradually reduced until the drainage could be removed on day 8 after ALVS. h Eleven days after ALVS, the chest radiogram showed no obvious recurrence of the chylothorax. The patient was discharged on the next day. ALVS Afferent lymphatic vessel sclerotherapy, CT Computed tomography, MCTs Medium-chain triglycerides, TL Transpedal lymphangiography

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