OPERATIVE THORACIC DUCTOGRAPHY

Scintigraphic demonstration of the thoracic duct following oral ingestion of 123I-heptadecanoic acid

A new noninvasive method for scintigraphic demonstration of the anatomic localization and function of the thoracic duct is described. Seven volunteers ingested 123I-heptadecanoic acid; approximately one hour later the entire thoracic duct was demonstrated and correspondingly a sharp rise in the plasma appearance rate of radioactivity was recorded. The method is simple and without side effects. The usefulness of this examination in clinical practice remains to be elucidated.

Primary chylopericardium

In a 23-year-old man with massive chylous pericardial effusion, oral administration of Sudan III and radio-active 131iodine-labelled triolein revealed an abnormal communication between the lymphatic system and the pericardial sac. Despite partial pericardiectomy and resection of the thoracic duct, the fluid reaccumulated, and a postoperative lymphangiogram showed an obstructed left thoracic duct. Resection of this left thoracic duct resulted in full recovery. This is the first reported case of this disease with a duplicate thoracic duct. Careful attention must be paid to the possibility of this variation before and during surgery.

Chylothorax: report of a case complicating ductus ligation through a median sternotomy, and review

An unusual case of chylothorax is described in a 4-year-old child after repair of a ventricular septal defect and ligation of a patent ductus arteriosus through a median sternotomy. Left chylothorax developed after a latent period of six days and was treated initially with continuous drainage and parenteral supplementation of proteins and lipids. Operative intervention with oversewing of the site of the leak in the anterior mediastinum proved necessary after three weeks. The anatomical variations of the thoracic duct are outlined to explain the occurrence of chylothorax after diverse intrathoracic operations. The physiological effects of a thoracic duct fistula and various aspects of management are reviewed.