Giant mediastinal lymphocele after esophagectomy successfully treated with thoracic duct embolization - PubMed (original) (raw)

Case Reports

Giant mediastinal lymphocele after esophagectomy successfully treated with thoracic duct embolization

Peng-Xu Ding et al. J Vasc Surg Cases Innov Tech. 2021.

Abstract

A 64-year old man had developed a giant mediastinal lymphocele after undergoing esophagectomy for the treatment of esophageal squamous cell carcinoma. The thoracic duct was embolized with six micro-coils, followed by embolization using a 1:3 mixture of N-butyl-2-cyanoacrylate (Histoacryl; B. Braun, Melsungen, Germany) and ethiodized oil. Resolution of the lymphocele was achieved within 5 days after embolization. To the best of our knowledge, ours is the first reported case of thoracic duct embolization for the treatment of mediastinal lymphocele.

Keywords: Intranodal lymphangiography; Lymphocele; Mediastinum; Percutaneous embolization; Thoracic duct.

© 2021 The Authors.

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Figures

Fig 1

Fig 1

Preoperative axial (A) and coronal (B) contrast-enhanced computed tomography (CT) scans of the chest showing a giant cystic lesion in the posterior mediastinum.

Fig 2

Fig 2

A, Spot fluoroscopic image showing a 21-gauge needle positioned within a right groin lymph node with subsequent ethiodized oil injection and opacification of the lymphatic vessels in the right pelvic region. B, Spot fluoroscopic image showing extravasation and collection of ethiodized oil at the level of the fifth thoracic vertebra (arrow). The draining catheter is also shown. C, Angiographic image through the microcatheter (arrowheads) showing abrupt termination of the thoracic duct, extravasation of contrast medium (arrow), and no opacification of the proximal thoracic duct. D, Spot fluoroscopic image showing embolization of the caudal thoracic duct with glue and coils (arrow).

Fig 3

Fig 3

Postoperative axial (A) and coronal (B) computed tomography (CT) scans of the chest 5 days after the procedure showing the cystic lesion had dramatically shrunk (arrow) and bubbles of air in the residual collection. Postoperative axial (C) and coronal (D) CT scans of the chest after the drainage catheter had been removed (6 weeks after the procedure) showing complete disappearance of the original cyst (arrow) and embolization glue and coils (arrowheads) in the thoracic duct.

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