Pamarthi et al [7] reported 85% technical success and 64% clinical success in 105 patients with all-cause chylous leaks. Additional series have yielded similar results. Collectively, TDE has higher clinical success treating traumatic compared with nontraumatic chyle leaks and with TDE compared with thoracic duct disruption [8,9,11,17]. Overall, acute complications associated with TDE are minor and generally self-limited and are estimated at 2% to 6% [5-7]. Long-term complications may be seen in up to 14% of patients and may include leg swelling, abdominal swelling, or chronic diarrhea [18]. Overview of Imaging Modalities Different imaging studies serve different purposes in the evaluation and treatment of chylothorax. Chest radiography Chest radiographs are routine examinations to evaluate dyspnea, particularly in postoperative scenarios and in patients who require intensive care. Radiographs can reliably detect pleural effusions or alternative diagnoses and monitor the position of support lines and tubes [19]. Although there is a high sensitivity for pleural effusions, this technique cannot reliably characterize the type of effusion. Ultrasound Ultrasound (US) is sensitive for the detection of pleural fluid but cannot definitively discriminate between the types of pleural effusion [20]. US is now commonly used to help guide thoracentesis. Similarly, US can be used to facilitate intranodal lymphangiography, which is becoming a more accepted technique. Beyond facilitating these procedures, the role of US is limited with regard to the evaluation and management of chylothorax [21]. Conventional lymphangiography Lymphangiography has historically been used to opacify lymphatic vessels, detect lymph nodes and metastatic lesions, and evaluate lymphatic flow.
Chylothorax Treatment Planning. Pamarthi et al [7] reported 85% technical success and 64% clinical success in 105 patients with all-cause chylous leaks. Additional series have yielded similar results. Collectively, TDE has higher clinical success treating traumatic compared with nontraumatic chyle leaks and with TDE compared with thoracic duct disruption [8,9,11,17]. Overall, acute complications associated with TDE are minor and generally self-limited and are estimated at 2% to 6% [5-7]. Long-term complications may be seen in up to 14% of patients and may include leg swelling, abdominal swelling, or chronic diarrhea [18]. Overview of Imaging Modalities Different imaging studies serve different purposes in the evaluation and treatment of chylothorax. Chest radiography Chest radiographs are routine examinations to evaluate dyspnea, particularly in postoperative scenarios and in patients who require intensive care. Radiographs can reliably detect pleural effusions or alternative diagnoses and monitor the position of support lines and tubes [19]. Although there is a high sensitivity for pleural effusions, this technique cannot reliably characterize the type of effusion. Ultrasound Ultrasound (US) is sensitive for the detection of pleural fluid but cannot definitively discriminate between the types of pleural effusion [20]. US is now commonly used to help guide thoracentesis. Similarly, US can be used to facilitate intranodal lymphangiography, which is becoming a more accepted technique. Beyond facilitating these procedures, the role of US is limited with regard to the evaluation and management of chylothorax [21]. Conventional lymphangiography Lymphangiography has historically been used to opacify lymphatic vessels, detect lymph nodes and metastatic lesions, and evaluate lymphatic flow.