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Postmastectomy/Axillary Node Dissection Chyloma: The Additional Value of SPECT/CT Lymphoscintigraphy.

Thang SP, Tong AK, Ng DC - J Breast Cancer (2014)

Bottom Line: However, considerable anatomical variation in the termination of the thoracic duct has been reported.Hence, during breast surgery, injury to the lateral terminating branch is not unlikely and might lead to retrograde chyle leak.In this case, additional hybrid single-photon emission computed tomography/computed tomography study was done, and has helped with the accurate identification of the chyle leakage site, thus aiding in surgical management.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore, Singapore.

ABSTRACT
After mastectomy and axillary node dissection, chylous leakage is rare. However, considerable anatomical variation in the termination of the thoracic duct has been reported. Hence, during breast surgery, injury to the lateral terminating branch is not unlikely and might lead to retrograde chyle leak. Herein, we describe a patient who had a chylous leakage at her wound site after a left simple mastectomy and axillary node dissection and for whom lymphoscintigraphy with Tc-99m albumin nanocolloid was performed. In this case, additional hybrid single-photon emission computed tomography/computed tomography study was done, and has helped with the accurate identification of the chyle leakage site, thus aiding in surgical management.

No MeSH data available.


Related in: MedlinePlus

Single-photon emission computed tomography/computed tomography (SPECT/CT) scan of the thorax. (A) SPECT/CT reveals focal uptake at the left axilla (arrow). (B) Correlative CT scan localized this uptake to be beyond the left subclavian vein, anterior to the left axillary vein, and inferior to the left biceps tendon (arrow). (C, D) This tracer uptake empties into the chyle collection (arrows). (E, F) Tracer uptake inferior to the chyle collection locates within the collection itself (arrow), as confirmed by correlative CT scan (arrow), likely representing nonuniformity of the chyle concentration.
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Figure 4: Single-photon emission computed tomography/computed tomography (SPECT/CT) scan of the thorax. (A) SPECT/CT reveals focal uptake at the left axilla (arrow). (B) Correlative CT scan localized this uptake to be beyond the left subclavian vein, anterior to the left axillary vein, and inferior to the left biceps tendon (arrow). (C, D) This tracer uptake empties into the chyle collection (arrows). (E, F) Tracer uptake inferior to the chyle collection locates within the collection itself (arrow), as confirmed by correlative CT scan (arrow), likely representing nonuniformity of the chyle concentration.

Mentions: SPECT/CT showed a large fluid collection (18×6 cm) with mild tracer uptake at the mastectomy site that was consistent with a chyle leak. The tracer uptake inferior to the chyle collection on planar imaging was found to be located within the collection itself on SPECT/CT, likely representing nonuniformity of chyle concentration (Figure 4). Focal uptake at the left axilla did not correlate with any obvious anatomical structures, but SPECT/CT localized this focus to be beyond the left subclavian vein, anterior to the left axillary vein, and inferior to the left biceps tendon, likely representing a leakage from a tiny branch of the thoracic duct. The tracer uptake gradually emptied into the chyle collection.


Postmastectomy/Axillary Node Dissection Chyloma: The Additional Value of SPECT/CT Lymphoscintigraphy.

Thang SP, Tong AK, Ng DC - J Breast Cancer (2014)

Single-photon emission computed tomography/computed tomography (SPECT/CT) scan of the thorax. (A) SPECT/CT reveals focal uptake at the left axilla (arrow). (B) Correlative CT scan localized this uptake to be beyond the left subclavian vein, anterior to the left axillary vein, and inferior to the left biceps tendon (arrow). (C, D) This tracer uptake empties into the chyle collection (arrows). (E, F) Tracer uptake inferior to the chyle collection locates within the collection itself (arrow), as confirmed by correlative CT scan (arrow), likely representing nonuniformity of the chyle concentration.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4197361&req=5

Figure 4: Single-photon emission computed tomography/computed tomography (SPECT/CT) scan of the thorax. (A) SPECT/CT reveals focal uptake at the left axilla (arrow). (B) Correlative CT scan localized this uptake to be beyond the left subclavian vein, anterior to the left axillary vein, and inferior to the left biceps tendon (arrow). (C, D) This tracer uptake empties into the chyle collection (arrows). (E, F) Tracer uptake inferior to the chyle collection locates within the collection itself (arrow), as confirmed by correlative CT scan (arrow), likely representing nonuniformity of the chyle concentration.
Mentions: SPECT/CT showed a large fluid collection (18×6 cm) with mild tracer uptake at the mastectomy site that was consistent with a chyle leak. The tracer uptake inferior to the chyle collection on planar imaging was found to be located within the collection itself on SPECT/CT, likely representing nonuniformity of chyle concentration (Figure 4). Focal uptake at the left axilla did not correlate with any obvious anatomical structures, but SPECT/CT localized this focus to be beyond the left subclavian vein, anterior to the left axillary vein, and inferior to the left biceps tendon, likely representing a leakage from a tiny branch of the thoracic duct. The tracer uptake gradually emptied into the chyle collection.

Bottom Line: However, considerable anatomical variation in the termination of the thoracic duct has been reported.Hence, during breast surgery, injury to the lateral terminating branch is not unlikely and might lead to retrograde chyle leak.In this case, additional hybrid single-photon emission computed tomography/computed tomography study was done, and has helped with the accurate identification of the chyle leakage site, thus aiding in surgical management.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore, Singapore.

ABSTRACT
After mastectomy and axillary node dissection, chylous leakage is rare. However, considerable anatomical variation in the termination of the thoracic duct has been reported. Hence, during breast surgery, injury to the lateral terminating branch is not unlikely and might lead to retrograde chyle leak. Herein, we describe a patient who had a chylous leakage at her wound site after a left simple mastectomy and axillary node dissection and for whom lymphoscintigraphy with Tc-99m albumin nanocolloid was performed. In this case, additional hybrid single-photon emission computed tomography/computed tomography study was done, and has helped with the accurate identification of the chyle leakage site, thus aiding in surgical management.

No MeSH data available.


Related in: MedlinePlus