Moreover, this adds little to the clinical care of a patient as the traumatic etiology is usually known and any information gained would be redundant if conventional lymphangiography was performed as part of TDE. Magnetic resonance imaging chest and abdomen The diagnostic benefit of MRI is negated in the setting of traumatic chylothoraces. However, the ability of MRI to map the lymphatic system can be of benefit in select cases where identifying the cisterna chyli and/or thoracic duct is difficult or conventional lymphangiography is unsuccessful [40-43]. Computed tomography chest and abdomen CT imaging is able to visualize portions of lymphatic system but provides less anatomic detail than MRI [36,47,48]. If the etiology is known, CT of the chest and abdomen, with or without intravenous contrast material, has little value in that it does not help guide therapy directed at chylothorax in most cases. Variant 2: Chylothorax treatment planning: nontraumatic or unknown etiology. Nontraumatic chylothorax accounts for approximately 46% of chylothoraces and can be subcategorized as resulting from malignancy, as occurs in 18% of all chylothoraces, or nonmalignant etiologies, which account for 28% of all chylothoraces [1,2,6,7]. Of the malignant etiologies, lymphoma is the leading cause, accounting for 75% of all malignant chylothoraces. Nonmalignant, nontraumatic chylothorax has been described in lymphangioleiomyomatosis, sarcoidosis, cirrhosis, heart failure, nephrotic syndrome, venous thrombosis, filariasis, venolymphatic malformations, and a variety of other congenital, idiopathic, and systemic diseases. Approximately 9% of all chylous effusions are idiopathic [1,2,6,7]. Imaging a patient with either a nontraumatic chylothorax or a chylothorax of unknown etiology serves to narrow the differential diagnosis, further characterize the underlying cause and its severity, and assist in treatment planning.
Chylothorax Treatment Planning. Moreover, this adds little to the clinical care of a patient as the traumatic etiology is usually known and any information gained would be redundant if conventional lymphangiography was performed as part of TDE. Magnetic resonance imaging chest and abdomen The diagnostic benefit of MRI is negated in the setting of traumatic chylothoraces. However, the ability of MRI to map the lymphatic system can be of benefit in select cases where identifying the cisterna chyli and/or thoracic duct is difficult or conventional lymphangiography is unsuccessful [40-43]. Computed tomography chest and abdomen CT imaging is able to visualize portions of lymphatic system but provides less anatomic detail than MRI [36,47,48]. If the etiology is known, CT of the chest and abdomen, with or without intravenous contrast material, has little value in that it does not help guide therapy directed at chylothorax in most cases. Variant 2: Chylothorax treatment planning: nontraumatic or unknown etiology. Nontraumatic chylothorax accounts for approximately 46% of chylothoraces and can be subcategorized as resulting from malignancy, as occurs in 18% of all chylothoraces, or nonmalignant etiologies, which account for 28% of all chylothoraces [1,2,6,7]. Of the malignant etiologies, lymphoma is the leading cause, accounting for 75% of all malignant chylothoraces. Nonmalignant, nontraumatic chylothorax has been described in lymphangioleiomyomatosis, sarcoidosis, cirrhosis, heart failure, nephrotic syndrome, venous thrombosis, filariasis, venolymphatic malformations, and a variety of other congenital, idiopathic, and systemic diseases. Approximately 9% of all chylous effusions are idiopathic [1,2,6,7]. Imaging a patient with either a nontraumatic chylothorax or a chylothorax of unknown etiology serves to narrow the differential diagnosis, further characterize the underlying cause and its severity, and assist in treatment planning.