277. SIMPLE METHOD: INGUINAL LYMPHANGIOGRAPHY FOR POSTOPERATIVE CHYLOTHORAX

Background

Chylothorax is a well-known complication of esophageal cancer surgery, with an incidence of approximately 1–3%. The main cause is intraoperative damage to the thoracic duct, which is often discovered after postoperation. If conservative treatment is chosen, lymphangiography with Lipiodol is the diagnostic and embolization procedure for exposed areas. Itkin et al. reported that improvement rate is approximately 70%. Pedal lymphangiography has been used in the past, but we perform lymphangiography from the inguinal lymph node.

Method

We inject lipiodol under ultrasound guidance.

A total of 6–10 mL injected into each bilateral inguinal lymph node.

The lipiodol drain upstream from the main lumbar lymphatic trunk and contrasts into the thoracic duct under fluoroscopy.

CT scans would be useful in the case that contrasts were unclear.

Result

If it is possible to inject lipiodol into the inguinal lymph nodes, even the thoracic ducts can be easily detected. With the classical method, an incision must be made between the first and second toes under local anesthesia, and minute lymph ducts must be identified and injected. However, if the inguinal lymph nodes are small, the drug tends to leak easily. Leakage is immediately detectable by fluoroscopy, so large leakage is unusual. If the drug is absorbed slowly, it remains subcutaneously after several months and can be identified as an artifact on abdominal X-rays or CT.

Conclusion

Lymphangiography from the inguinal lymph node is a relatively safe and simple method of examination, compared to the intervention from the dorsal foot. No skin incision on the dorsal foot is required, only an echo guided puncture is necessary. The examination time is short, and the patient burden is low. The procedure is not particularly difficult, so it can be performed even at small hospitals.