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Anatomic and Functional Evaluation of Central Lymphatics With Noninvasive Magnetic Resonance Lymphangiography

View Article: PubMed Central - PubMed

ABSTRACT

Accurate assessment of the lymphatic system has been limited due to the lack of optimal diagnostic methods. Recently, we adopted noncontrast magnetic resonance (MR) lymphangiography to evaluate the central lymphatic channel. We aimed to investigate the feasibility and the clinical usefulness of noninvasive MR lymphangiography for determining lymphatic disease.

Ten patients (age range 42–72 years) with suspected chylothorax (n = 7) or lymphangioma (n = 3) who underwent MR lymphangiography were included in this prospective study. The thoracic duct was evaluated using coronal and axial images of heavily T2-weighted sequences, and reconstructed maximum intensity projection. Two radiologists documented visualization of the thoracic duct from the level of the diaphragm to the thoracic duct outlet, and also an area of dispersion around the chyloma or direct continuity between the thoracic duct and mediastinal cystic mass.

The entire thoracic duct was successfully delineated in all patients. Lymphangiographic findings played a critical role in identifying leakage sites in cases of postoperative chylothorax, and contributed to differential diagnosis and confirmation of continuity with the thoracic duct in cases of lymphangioma, and also in diagnosing Gorham disease, which is a rare disorder. In patients who underwent surgery, intraoperative findings were matched with lymphangiographic imaging findings.

Nonenhanced MR lymphangiography is a safe and effective method for imaging the central lymphatic system, and can contribute to differential diagnosis and appropriate preoperative evaluation of pathologic lymphatic problems.

No MeSH data available.


Related in: MedlinePlus

Postoperative chylothorax in a 68-year-old male who underwent right lower lobectomy due to lung cancer (T2aN0M0, stage IB). A, Posteroanterior chest radiography obtained 10 days after surgery shows large right pleural effusion despite chest tube drainage. B, Axial T2-weighted MR imaging obtained the same day demonstrates a large right pleural effusion continuous into the mediastinum between the aorta and azygos vein (white open arrow). C, Axial heavily T2-weighted MR imaging demonstrates a leak site (white arrows) in thoracic duct near the azygos arch. MR = magnetic resonance.
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Figure 1: Postoperative chylothorax in a 68-year-old male who underwent right lower lobectomy due to lung cancer (T2aN0M0, stage IB). A, Posteroanterior chest radiography obtained 10 days after surgery shows large right pleural effusion despite chest tube drainage. B, Axial T2-weighted MR imaging obtained the same day demonstrates a large right pleural effusion continuous into the mediastinum between the aorta and azygos vein (white open arrow). C, Axial heavily T2-weighted MR imaging demonstrates a leak site (white arrows) in thoracic duct near the azygos arch. MR = magnetic resonance.

Mentions: Among 6 patients who developed postoperative chylothorax, chyle leakage occurred after esophagectomy for esophageal cancer (n = 1), after lobectomy for lung cancer (n = 4), and after mass excision for lipoma (n = 1). In 4 of 6 (67%) patients with postoperative chylothorax, the chyle leakage site was identified on MR lymphangiography (see video, Supplemental Digital Content 1, which demonstrates the chyle leakage site; annotated with arrows and course of thoracic duct; annotated with circle). Lymphatic leakage was not identified in the remaining 2 patients. Despite conservative management such as drainage tube insertion, medium-chain triglyceride diet, or total parenteral nutrition, 2 patients with persistent high-output chyle leakage underwent surgical exploration with thoracic duct ligation. The leakage sites founded to be matched with MR lymphangiographic imaging findings (Figure 1). In the remaining 4 patients, the daily amount of fluid drainage decreased after lymphangiography. For this reason, conservative treatment was continued in these patients.


Anatomic and Functional Evaluation of Central Lymphatics With Noninvasive Magnetic Resonance Lymphangiography
Postoperative chylothorax in a 68-year-old male who underwent right lower lobectomy due to lung cancer (T2aN0M0, stage IB). A, Posteroanterior chest radiography obtained 10 days after surgery shows large right pleural effusion despite chest tube drainage. B, Axial T2-weighted MR imaging obtained the same day demonstrates a large right pleural effusion continuous into the mediastinum between the aorta and azygos vein (white open arrow). C, Axial heavily T2-weighted MR imaging demonstrates a leak site (white arrows) in thoracic duct near the azygos arch. MR = magnetic resonance.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998379&req=5

Figure 1: Postoperative chylothorax in a 68-year-old male who underwent right lower lobectomy due to lung cancer (T2aN0M0, stage IB). A, Posteroanterior chest radiography obtained 10 days after surgery shows large right pleural effusion despite chest tube drainage. B, Axial T2-weighted MR imaging obtained the same day demonstrates a large right pleural effusion continuous into the mediastinum between the aorta and azygos vein (white open arrow). C, Axial heavily T2-weighted MR imaging demonstrates a leak site (white arrows) in thoracic duct near the azygos arch. MR = magnetic resonance.
Mentions: Among 6 patients who developed postoperative chylothorax, chyle leakage occurred after esophagectomy for esophageal cancer (n = 1), after lobectomy for lung cancer (n = 4), and after mass excision for lipoma (n = 1). In 4 of 6 (67%) patients with postoperative chylothorax, the chyle leakage site was identified on MR lymphangiography (see video, Supplemental Digital Content 1, which demonstrates the chyle leakage site; annotated with arrows and course of thoracic duct; annotated with circle). Lymphatic leakage was not identified in the remaining 2 patients. Despite conservative management such as drainage tube insertion, medium-chain triglyceride diet, or total parenteral nutrition, 2 patients with persistent high-output chyle leakage underwent surgical exploration with thoracic duct ligation. The leakage sites founded to be matched with MR lymphangiographic imaging findings (Figure 1). In the remaining 4 patients, the daily amount of fluid drainage decreased after lymphangiography. For this reason, conservative treatment was continued in these patients.

View Article: PubMed Central - PubMed

ABSTRACT

Accurate assessment of the lymphatic system has been limited due to the lack of optimal diagnostic methods. Recently, we adopted noncontrast magnetic resonance (MR) lymphangiography to evaluate the central lymphatic channel. We aimed to investigate the feasibility and the clinical usefulness of noninvasive MR lymphangiography for determining lymphatic disease.

Ten patients (age range 42–72 years) with suspected chylothorax (n = 7) or lymphangioma (n = 3) who underwent MR lymphangiography were included in this prospective study. The thoracic duct was evaluated using coronal and axial images of heavily T2-weighted sequences, and reconstructed maximum intensity projection. Two radiologists documented visualization of the thoracic duct from the level of the diaphragm to the thoracic duct outlet, and also an area of dispersion around the chyloma or direct continuity between the thoracic duct and mediastinal cystic mass.

The entire thoracic duct was successfully delineated in all patients. Lymphangiographic findings played a critical role in identifying leakage sites in cases of postoperative chylothorax, and contributed to differential diagnosis and confirmation of continuity with the thoracic duct in cases of lymphangioma, and also in diagnosing Gorham disease, which is a rare disorder. In patients who underwent surgery, intraoperative findings were matched with lymphangiographic imaging findings.

Nonenhanced MR lymphangiography is a safe and effective method for imaging the central lymphatic system, and can contribute to differential diagnosis and appropriate preoperative evaluation of pathologic lymphatic problems.

No MeSH data available.


Related in: MedlinePlus