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Mitsui K, Narushima M, Danno K, Ishiura R, Banda CH. Intra-lymphocele microsurgical identification of causative afferent vessels for effective lymphaticovenular anastomosis in lymphocele treatment: A case report. Microsurgery 2024; 44:e31002. [PMID: 36571804 DOI: 10.1002/micr.31002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/22/2022] [Accepted: 12/14/2022] [Indexed: 12/27/2022]
Abstract
Lymphoceles are an important complication of pelvic and abdominal surgery with a reported incidence of 11%-88%. Conventional treatment includes compression, puncture aspiration, sclerotherapy, and ligation but recurrence is not uncommon and is difficult to treat. Recently, microsurgical lymphaticolymphatic anastomosis, lymphaticovenular anastomosis (LVA) and reconstruction of lymphatic circulation with flaps are increasingly being utilized for lymphocele treatment. Effective microsurgical treatment requires precise identification of the causative afferent vessels for the most efficient circulatory by-pass. However, direct identification of these vessels using traditional lymphoscintigraphy and near infrared lymphography is challenging and often not possible. We report the case of a 55-year-old woman who presented with bilateral inguinal lymphoceles and lymphedema following pelvic surgery for vulvovaginal cancer. Bilateral multiple LVAs of the lower extremities were performed and the lower limb circumferences reduced postoperatively, however both lymphoceles still persisted. The patient was successfully treated by approaching the lymphoceles from inside the lymphocele cavity. The causative afferent lymph vessels were directly identified microsurgically by gentle pressure on the inner wall and causative afferent lymph vessel lymphaticovenular anastomosis was performed. The lymphoceles resolved promptly after surgery without complications, and no recurrence was observed on 5 years follow-up. This case report presents an innovative microsurgical approach to lymphocele treatment, including examination and techniques to identify the causative afferent lymphatic vessels for effective anastomosis. We report this case to demonstrate the importance of lymphatic vessel selection in the microsurgical treatment of lymphocele.
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Affiliation(s)
- Kohei Mitsui
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Kanako Danno
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Ryohei Ishiura
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Chihena H Banda
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
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Lee CD, Kwiecien G, Wenzinger EJ, Lee I, Cakmakoglu C, Schwarz GS. Long-term efficacy of lymphovenous anastomosis for the treatment of retroperitoneal lymphangiectasia: A case report and a review of literature. Microsurgery 2023; 43:63-67. [PMID: 35014739 DOI: 10.1002/micr.30859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 09/29/2021] [Accepted: 11/29/2021] [Indexed: 01/12/2023]
Abstract
Lymphovenous anastomosis (LVA) represents an alternative treatment for retroperitoneal lymphangiectasia. In contrast to sclerotherapy or excision, which may risk lymphatic obstruction and subsequent lymphedema, LVA preserves existing lymphatic architecture and transit. This report shows long-term efficacy of LVA for functional decompression of a symptomatic pathologically dilatated retroperitoneal lymphatics. A 47-year-old female with retroperitoneal lymphangiectasia refractory to multiple percutaneous drainages and treatments with sclerosing agents underwent LVA with anastomosis of a dominant segment of retroperitoneal lymphangiectasia to the deep inferior epigastric vein. Postoperative serial magnetic resonance imaging with 3-dimensional volume calculation over the 27 months follow-up showed evidence of decompression of the lesion with patent bypass. There were no known immediate complications nor requirement of further interventions. The patient's subjective pain also decreased substantially. This report confirms long-term efficacy of LVA for retroperitoneal lymphangiectasia as an alternative to sclerotherapy and surgical excision in the setting of previously failed treatments.
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Affiliation(s)
| | - Grzegorz Kwiecien
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eric J Wenzinger
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Irene Lee
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Cagri Cakmakoglu
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Graham S Schwarz
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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Amirtharaja A, Quek JZ, Battison S, Srinivasan B. Cervical thoracic duct cyst: a conservative resolution. BMJ Case Rep 2022; 15:e250554. [PMID: 36261221 PMCID: PMC9582293 DOI: 10.1136/bcr-2022-250554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
A woman in her 70s presented with an enlarging, asymptomatic palpable mass in the left supraclavicular fossa. The clinical impression was of a lipoma. Imaging showed a cystic lesion with continuity of a tubular structure leading to the carotid sheath. Cytology was consistent with thoracic duct sampling. A diagnosis of the rare entity of a thoracic duct cyst with supraclavicular extension was made. This was managed conservatively via repeated aspirations which reduced the size of the mass.
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Affiliation(s)
- Aimee Amirtharaja
- Oral and Maxillofacial Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | | | - Sobana Battison
- Department of Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Planchette J, Jaccard C, Nigron A, Chadeyras JB, Le Guenno G, Castagne B, Jamilloux Y, Resseguier AS, Sève P. Recurrent thoracic duct cyst of the left supraclavicular fossa: A retrospective study of 6 observational case series and literature review. Medicine (Baltimore) 2021; 100:e28213. [PMID: 34918683 PMCID: PMC8678004 DOI: 10.1097/md.0000000000028213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/21/2021] [Accepted: 11/20/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT The transient occlusion of the terminal thoracic duct is a rare disease responsible for renitent supraclavicular cysts. The aim of this study was to describe the clinical characteristics, evolution, and treatment.A retrospective multicenter study and literature review was carried out. The literature search (PubMed) was conducted including data up to 31 December 2020 and PRISMA guidelines were respected.This study identified 6 observational cases between September 2010 and December 2020. The search results indicated a total of 24 articles of which 19 were excluded due to the lack of recurrent swelling or the unavailability of full texts (n = 5). Fourteen patients (8 from literature) mostly reported a noninflammatory, painless renitent mass in the supraclavicular fossa which appeared rapidly over a few hours and disappeared spontaneously over an average of 8 days (range: from about 2 hours to 10 days). Anamnesis indicated a high-fat intake during the preceding days in all cases and 7 from literature found in the Medline databases. Recurrences were noted in 10 patients. Thoracic duct imaging was performed in all cases to detect abnormalities or extrinsic compression as well as to eliminate differential diagnoses.A painless, fluctuating, noninflammatory, and recurrent swelling of the left supraclavicular fossa in patients evoking an intermittent obstruction of the terminal portion of the thoracic duct was identified. A low-fat diet was found as safe and effective treatment.
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Affiliation(s)
- Julie Planchette
- Department of Internal Medicine and Rheumatology, Hospital Emile Roux, Le Puy en Velay, France
| | - Clara Jaccard
- Department of Internal Medicine and Rheumatology, Hospital Emile Roux, Le Puy en Velay, France
| | - Audrey Nigron
- Department of Radiology, Hopital Emile Roux, Le Puy en Velay, France
| | | | | | - Benjamin Castagne
- Department of Internal Medicine and Rheumatology, Hospital Emile Roux, Le Puy en Velay, France
| | - Yvan Jamilloux
- Department of Internal Medicine, Lyon University Hospital, Lyon, France
| | - Anne-Sophie Resseguier
- Department of Internal Medicine and Rheumatology, Hospital Emile Roux, Le Puy en Velay, France
| | - Pascal Sève
- Department of Internal Medicine, Lyon University Hospital, Lyon, France
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM Lyon, France
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5
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Noor A, Lam B, Ho JPK, Kuo TSW. Traumatic rupture of a cervical thoracic duct cyst: an unusual presentation of a rare diagnosis. ANZ J Surg 2021; 92:1514-1515. [PMID: 34698440 DOI: 10.1111/ans.17305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Anthony Noor
- Department of Otolaryngology Head and Neck Surgery, Gosford District Hospital, Gosford, New South Wales, Australia
| | - Brian Lam
- Department of Otolaryngology Head and Neck Surgery, Gosford District Hospital, Gosford, New South Wales, Australia
| | - Joyce Pui Kiu Ho
- Department of Otolaryngology Head and Neck Surgery, Gosford District Hospital, Gosford, New South Wales, Australia
| | - Tony Shih-Wei Kuo
- Department of Otolaryngology Head and Neck Surgery, Gosford District Hospital, Gosford, New South Wales, Australia.,Department of Otolaryngology Head and Neck Surgery, Macquarie University Hospital, Macquarie Park, New South Wales, Australia
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Parmeggiani D, Gualtieri G, Terracciano G, Gambardella C, Parisi S, Brusciano L, Ruggiero R, Docimo L. Prolonged iatrogenic thoracic duct chylous fistula in Neck Surgery: conservative management or surgery? A Literature review. Scand J Surg 2021; 110:550-556. [PMID: 33423617 DOI: 10.1177/1457496920987076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Thoracic duct chylous fistula is a rare complication following neck surgery, especially for malignant disease. Despite its low incidence, it can be a life-threatening postoperative complication increasing the risk of infection, bleeding, hypovolemia, electrolyte imbalance, and malnutrition. Currently, the management of thoracic duct fistula is not standardized yet. It can range from conservative to surgical approaches, and even when surgery indication occurs, there is no unanimous agreement on timing and operative steps, so the surgical approach still remains mostly subjective, in accordance with clinical conditions of the patients and with surgeon's experience. AIMS The aim of the study was to search into Literature a common accepted behaviour in thoracic duct chylous fistula occurring. METHODS A literature review was carried out. Conservative treatments include fasting associated with total parental nutrition or low-fat diet, compressive dressings, and octreotide administration. If conservative treatment fails, in order to avoid dangerous consequences, functional repair of the thoracic duct injury with lymphovenous microanastomosis should be the preferred solution, rather than an approach that obliterates the thoracic duct or lymphatic-chylous pathways, such as thoracic duct embolization, therapeutic lymphangiography, and thoracic duct ligation. CONCLUSIONS In our experience, patients undergone thyroidectomy and neck dissection for thyroid-differentiated cancer, who report an unrecognized thoracic duct chylous fistula after surgery, must be treated via integrated conservative and surgical treatment. A literature review about thoracic duct chylous fistula following neck surgery, focusing on the current management and therapeutic approach, was furthermore carried out, in order to delineate the actual therapeutic options in case of thoracic duct chylous fistula occurrence.
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Affiliation(s)
- D Parmeggiani
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - G Gualtieri
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - G Terracciano
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - C Gambardella
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - S Parisi
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - L Brusciano
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - R Ruggiero
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - L Docimo
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
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Abelardo E, Shastri P, Prabhu V. Variations in the Management of Cervical Thoracic Duct Cyst. Biomed Hub 2020; 5:7-14. [PMID: 32775334 DOI: 10.1159/000507275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/17/2020] [Indexed: 11/19/2022] Open
Abstract
We present an uncomplicated case report of a cervical thoracic duct cyst (CTDC) in a 61-year-old woman treated with surgical excision. We reviewed 47 similar cases since it was first described in 1964 and evaluated the different diagnostic and management approaches. Previously believed to be the gold standard tool for evaluation, lymphangiography is now less popular due to advent of high-resolution imaging combined with aspiration techniques. CTDC treatment includes observation, low-fat diet, repeated aspirations, external pressure, sclerotherapy, embolisation, and surgical intervention. The preferred management of choice to date is surgical excision.
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Affiliation(s)
- Edgardo Abelardo
- ENT Department, Hywel Dda University Health Board, Carmarthen, United Kingdom
| | - Priyanka Shastri
- ENT Department, Hywel Dda University Health Board, Carmarthen, United Kingdom
| | - Vinod Prabhu
- ENT Department, Hywel Dda University Health Board, Carmarthen, United Kingdom
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Carreira-Delgado M, Fernández-Rodríguez E, Martínez-Míguez M, Álvarez-Martín MJ, Nuño Vázquez-Garza JM. [Cervical thoracic duct cyst: An uncommon entity]. CIR CIR 2017; 85 Suppl 1:40-43. [PMID: 28040230 DOI: 10.1016/j.circir.2016.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 11/17/2016] [Accepted: 11/26/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cervical thoracic duct cysts are a rare anomaly. OBJECTIVE To report a case of cervical thoracic duct cyst, and perform a literature review. CLINICAL CASE A 78-year-old female, with a one-year history of a left-sided asymptomatic supraclavicular cystic mass. Computerized tomography revealed a cystic mass 42mm in diameter. We performed a fine needle aspiration puncture, obtaining a thick, milky, whitish liquid. The patient underwent surgery; finding a left-sided supraclavicular cystic mass, with some lymph vessels heading towards the jugulo subclavian venous junction. We performed a ligation of these lymph vessels and resection of the mass. The histopathologic study confirmed the diagnosis of thoracic duct cyst. CONCLUSION Diagnosis of cervical thoracic duct cyst should be suspected with a cystic lesion in the left supraclavicular region, which when perforated exudes a very distinctive thick milky, whitish liquid with a high content of lymphocytes and triglycerides. Treatment should be complete removal with ligation of the lymphatic afferent vessels.
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Affiliation(s)
- Manuel Carreira-Delgado
- Servicio de Cirugía General, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Vigo, España.
| | - Elvira Fernández-Rodríguez
- Servicio de Cirugía General, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Vigo, España
| | | | - María Jesús Álvarez-Martín
- Servicio de Anatomía Patológica, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Vigo, España
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Varona Porres D, Persiva Ó, Pallisa E, Sansano I. Diagnostic imaging in spontaneous rupture of a thoracic duct cyst in the mediastinum. RADIOLOGIA 2016; 58:491-495. [PMID: 27117300 DOI: 10.1016/j.rx.2016.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/10/2016] [Accepted: 03/13/2016] [Indexed: 11/26/2022]
Abstract
Thoracic duct cysts in the mediastinum are extremely rare; they can give rise to chylothorax when they spontaneously rupture or after they are operated on. We present the case of an adult woman with a thoracic duct cyst in the mediastinum and chylothorax from its spontaneous rupture; to our knowledge, this phenomenon has not been specifically reported before. We describe the clinical and radiological findings, the therapeutic management, and the pathology findings, reviewing the literature for this entity.
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Affiliation(s)
- D Varona Porres
- Departamento de Radiodiagnóstico, Hospital Vall d'Hebron, Barcelona, España.
| | - Ó Persiva
- Departamento de Radiodiagnóstico, Hospital Vall d'Hebron, Barcelona, España
| | - E Pallisa
- Departamento de Radiodiagnóstico, Hospital Vall d'Hebron, Barcelona, España
| | - I Sansano
- Departamento de Anatomía Patológica, Hospital Vall d'Hebron, Barcelona, España
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