Chylothorax Treatment Planning Lymphangiography is able to define the site of the leak, diagnose alternative lymphatic vessel diseases, and prevent unnecessary procedures. Several authors have documented the therapeutic benefit of lymphangiography to occlude the site of leakage in 37% to 70% of patients without additional procedures [24-30]. Moreover, as detailed earlier, lymphangiography is intrinsic to the performance of TDE and guides the transabdominal access to the cisterna chyli and thoracic duct [14-16]. Magnetic resonance imaging chest and abdomen Visualization of the cisterna chyli, thoracic duct, and tributary lymphatic vessels with magnetic resonance imaging (MRI) was described in healthy volunteers as early as 1999 [34]. Initial MR lymphangiography technique involved unenhanced thin-collimated axial and coronal sequences similar to magnetic resonance cholangiopancreatography. Further refinements of sequences, particularly heavily T2-weighted sequences with and without and fat suppression, combined with 3-D techniques, maximum-intensity projections, and higher magnetic fields, increased the reliability and quality of MR lymphangiography [35-39]. Morphological features of the cisterna chyli and thoracic duct can be noted with identification of these structures in over 90% of preoperative patients, potentially providing valuable information and decreasing their risk of lymphatic leak [40- 43]. The vast majority of studies are performed with unenhanced techniques, although delayed-phase cisterna chyli enhancement has been noted [44]. Respiratory gating and further technical refinements have the potential to better elucidate minor lymphatic vessels and lymphatic vessels in antidependent areas, which may not be seen through conventional lymphangiography. Recent studies are beginning to document the feasibility of using gadolinium- based contrast material injection within groin lymph nodes or in the web spaces between toes.
Chylothorax Treatment Planning. Chylothorax Treatment Planning Lymphangiography is able to define the site of the leak, diagnose alternative lymphatic vessel diseases, and prevent unnecessary procedures. Several authors have documented the therapeutic benefit of lymphangiography to occlude the site of leakage in 37% to 70% of patients without additional procedures [24-30]. Moreover, as detailed earlier, lymphangiography is intrinsic to the performance of TDE and guides the transabdominal access to the cisterna chyli and thoracic duct [14-16]. Magnetic resonance imaging chest and abdomen Visualization of the cisterna chyli, thoracic duct, and tributary lymphatic vessels with magnetic resonance imaging (MRI) was described in healthy volunteers as early as 1999 [34]. Initial MR lymphangiography technique involved unenhanced thin-collimated axial and coronal sequences similar to magnetic resonance cholangiopancreatography. Further refinements of sequences, particularly heavily T2-weighted sequences with and without and fat suppression, combined with 3-D techniques, maximum-intensity projections, and higher magnetic fields, increased the reliability and quality of MR lymphangiography [35-39]. Morphological features of the cisterna chyli and thoracic duct can be noted with identification of these structures in over 90% of preoperative patients, potentially providing valuable information and decreasing their risk of lymphatic leak [40- 43]. The vast majority of studies are performed with unenhanced techniques, although delayed-phase cisterna chyli enhancement has been noted [44]. Respiratory gating and further technical refinements have the potential to better elucidate minor lymphatic vessels and lymphatic vessels in antidependent areas, which may not be seen through conventional lymphangiography. Recent studies are beginning to document the feasibility of using gadolinium- based contrast material injection within groin lymph nodes or in the web spaces between toes.