3
|
Zurcher KS, Huynh KN, Khurana A, Majdalany BS, Toskich B, Kriegshauser JS, Patel IJ, Naidu SG, Oklu R, Alzubaidi SJ. Interventional Management of Acquired Lymphatic Disorders. Radiographics 2022; 42:1621-1637. [PMID: 36190865 DOI: 10.1148/rg.220032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The lymphatic system is a complex network of tissues, vessels, and channels found throughout the body that assists in fluid balance and immunologic function. When the lymphatic system is disrupted related to idiopathic, iatrogenic, or traumatic disorders, lymphatic leaks can result in substantial morbidity and/or mortality. The diagnosis and management of these leaks is challenging. Modern advances in lymphatic imaging and interventional techniques have made radiology critical in the multidisciplinary management of these disorders. The authors provide a review of conventional and clinically relevant variant lymphatic anatomy and recent advances in diagnostic techniques such as MR lymphangiography. A detailed summary of technical factors related to percutaneous lymphangiography and lymphatic intervention is presented, including transpedal and transnodal lymphangiography. Traditional transabdominal access and retrograde access to the central lymph nodes and thoracic duct embolization techniques are outlined. Newer techniques including transhepatic lymphangiography and thoracic duct stent placement are also detailed. For both diagnostic and interventional radiologists, an understanding of lymphatic anatomy and modern diagnostic and interventional techniques is vital to the appropriate treatment of patients with acquired lymphatic disorders. ©RSNA, 2022.
Collapse
Affiliation(s)
- Kenneth S Zurcher
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (K.S.Z., J.S.K., I.J.P., S.G.N., R.O., S.J.A.); Department of Radiological Sciences, University of California, Irvine, Orange, Calif (K.N.H.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); Department of Radiology, University of Vermont, Burlington, VT (B.S.M.); and Division of Vascular and Interventional Radiology, Mayo Clinic Jacksonville, Jacksonville, Fla (B.T.)
| | - Kenneth N Huynh
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (K.S.Z., J.S.K., I.J.P., S.G.N., R.O., S.J.A.); Department of Radiological Sciences, University of California, Irvine, Orange, Calif (K.N.H.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); Department of Radiology, University of Vermont, Burlington, VT (B.S.M.); and Division of Vascular and Interventional Radiology, Mayo Clinic Jacksonville, Jacksonville, Fla (B.T.)
| | - Aditya Khurana
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (K.S.Z., J.S.K., I.J.P., S.G.N., R.O., S.J.A.); Department of Radiological Sciences, University of California, Irvine, Orange, Calif (K.N.H.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); Department of Radiology, University of Vermont, Burlington, VT (B.S.M.); and Division of Vascular and Interventional Radiology, Mayo Clinic Jacksonville, Jacksonville, Fla (B.T.)
| | - Bill S Majdalany
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (K.S.Z., J.S.K., I.J.P., S.G.N., R.O., S.J.A.); Department of Radiological Sciences, University of California, Irvine, Orange, Calif (K.N.H.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); Department of Radiology, University of Vermont, Burlington, VT (B.S.M.); and Division of Vascular and Interventional Radiology, Mayo Clinic Jacksonville, Jacksonville, Fla (B.T.)
| | - Beau Toskich
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (K.S.Z., J.S.K., I.J.P., S.G.N., R.O., S.J.A.); Department of Radiological Sciences, University of California, Irvine, Orange, Calif (K.N.H.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); Department of Radiology, University of Vermont, Burlington, VT (B.S.M.); and Division of Vascular and Interventional Radiology, Mayo Clinic Jacksonville, Jacksonville, Fla (B.T.)
| | - J Scott Kriegshauser
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (K.S.Z., J.S.K., I.J.P., S.G.N., R.O., S.J.A.); Department of Radiological Sciences, University of California, Irvine, Orange, Calif (K.N.H.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); Department of Radiology, University of Vermont, Burlington, VT (B.S.M.); and Division of Vascular and Interventional Radiology, Mayo Clinic Jacksonville, Jacksonville, Fla (B.T.)
| | - Indravadan J Patel
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (K.S.Z., J.S.K., I.J.P., S.G.N., R.O., S.J.A.); Department of Radiological Sciences, University of California, Irvine, Orange, Calif (K.N.H.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); Department of Radiology, University of Vermont, Burlington, VT (B.S.M.); and Division of Vascular and Interventional Radiology, Mayo Clinic Jacksonville, Jacksonville, Fla (B.T.)
| | - Sailendra G Naidu
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (K.S.Z., J.S.K., I.J.P., S.G.N., R.O., S.J.A.); Department of Radiological Sciences, University of California, Irvine, Orange, Calif (K.N.H.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); Department of Radiology, University of Vermont, Burlington, VT (B.S.M.); and Division of Vascular and Interventional Radiology, Mayo Clinic Jacksonville, Jacksonville, Fla (B.T.)
| | - Rahmi Oklu
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (K.S.Z., J.S.K., I.J.P., S.G.N., R.O., S.J.A.); Department of Radiological Sciences, University of California, Irvine, Orange, Calif (K.N.H.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); Department of Radiology, University of Vermont, Burlington, VT (B.S.M.); and Division of Vascular and Interventional Radiology, Mayo Clinic Jacksonville, Jacksonville, Fla (B.T.)
| | - Sadeer J Alzubaidi
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (K.S.Z., J.S.K., I.J.P., S.G.N., R.O., S.J.A.); Department of Radiological Sciences, University of California, Irvine, Orange, Calif (K.N.H.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.K.); Department of Radiology, University of Vermont, Burlington, VT (B.S.M.); and Division of Vascular and Interventional Radiology, Mayo Clinic Jacksonville, Jacksonville, Fla (B.T.)
| |
Collapse
|
5
|
Nguyen TK, Luong TH, Nguyen NC, Nguyen HH, Le VK, Trinh HS, Do HD, Le VD, Nguyen NH. Hepatic lymphorrhea following pancreaticoduodenectomy: Preliminary diagnosis and treatment experience from case series of four patients. Ann Med Surg (Lond) 2021; 68:102648. [PMID: 34386232 PMCID: PMC8346360 DOI: 10.1016/j.amsu.2021.102648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Hepatic lymphorrhea (HL) is an uncommon but potentially life-threatening type of postoperative lymphatic leakage, especially following pancreaticoduodenectomy. Case presentation We herein report a case series of four patients with HL following pancreaticoduodenectomy that presented to the department with a severe clinical picture with the discovery in imaging and intraperitoneal fluid's tests. All our patients presented with a condition of Hepatic lymphorrhea secondary to pancreaticoduodenectomy, which were treated successfully with percutaneous hepatic lymphangiography (HLG). Discussion Hepatic lymphorrhea is an uncommon but potentially life-threatening complication following pancreaticoduodenectomy. Periportal lymphatic vessels, which was often isolated and dissected especially with extended lymphadenectomy, is potentially damaged and caused resistant chylous leakage. Newly techniques are updated and applied in diagnosis and treatment for this difficult-to-treat complication, one of them is percutaneous Hepatic Lymphangiography (HLG). Conclusion HLG with percutaneous access could be effective to identify and terminate the chylous fistula from periportal lymphatic vessels after pancreaticoduodenectomy. Hepatic lymphorrhea is a rare, life-threatening complication of pancreaticoduodenectomy. Periportal lymphatic vessels was a potential location of lymphatic fistula and leakage. This complication can be diagnosed with imaging and intraperitoneal fluid's tests. Hepatic lymphangiography is a minor-invasive therapy to close the lymphatic fistula.
Collapse
Affiliation(s)
- Thanh Khiem Nguyen
- Department of Gastrointestinal and Hepato-pancreato-biliary Surgery, Bach Mai Hospital, Hanoi, Viet Nam
| | - Tuan Hiep Luong
- Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam
| | - Ngoc Cuong Nguyen
- Department of Diagnostic and Interventional Radiology, Hospital of Hanoi Medical University, Hanoi, Viet Nam
| | - Ham Hoi Nguyen
- Department of Gastrointestinal and Hepato-pancreato-biliary Surgery, Bach Mai Hospital, Hanoi, Viet Nam
| | - Van Khang Le
- Department of Diagnostic and Interventional Radiology, Bach Mai Hospital, Hanoi, Viet Nam
| | - Hong Son Trinh
- Department of Oncology, Viet Duc University Hospital, Hanoi, Viet Nam
| | - Hai Dang Do
- Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam
| | - Van Duy Le
- Department of Gastrointestinal and Hepato-pancreato-biliary Surgery, Bach Mai Hospital, Hanoi, Viet Nam
| | - Ngoc Hung Nguyen
- Department of Gastrointestinal and Hepato-pancreato-biliary Surgery, Bach Mai Hospital, Hanoi, Viet Nam
| |
Collapse
|
7
|
Nguyen NC, Inoue M, Le TL, Pham HC, Trinh HS, Pham DH, Nguyen H, Tran AT, Vu DL, Delphine N. Intrahepatic lymphatic channel sclerotic embolization for treatment of postoperative lymphatic ascites: a report of 3 cases. Radiol Case Rep 2020; 15:2353-2357. [PMID: 32994840 PMCID: PMC7501473 DOI: 10.1016/j.radcr.2020.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 08/31/2020] [Accepted: 09/08/2020] [Indexed: 12/28/2022] Open
Abstract
Postoperative hepatic lymphorrhea is extremely rare and there is no standard treatment for this condition. We report the cases of 3 men, 32-, 56-, and 37-year-old, with postoperative hepatic lymphorrhea, which was refractory to conservative treatment. Transhepatic lymphangiography allowed locating the lymphatic leak and treating it with hepatic lymphatic vessels injection of foam sclerotic agent. This technique seems efficient and safe.
Collapse
Affiliation(s)
- Ngoc Cuong Nguyen
- Radiology Department, Hanoi University Hospital, Hanoi, Vietnam
- Corresponding author.
| | | | - Tuan Linh Le
- Radiology Department, Hanoi University Hospital, Hanoi, Vietnam
| | - Hong Canh Pham
- Radiology Department, Hanoi University Hospital, Hanoi, Vietnam
| | | | - Duc Huan Pham
- Department of Surgery, Hanoi University Hospital, Hanoi, Vietnam
| | - Hoang Nguyen
- Department of Surgery, Hanoi University Hospital, Hanoi, Vietnam
| | - Anh Tuan Tran
- Radiology Department, Bach Mai Hospital, Hanoi, Vietnam
| | - Dang Luu Vu
- Radiology Department, Bach Mai Hospital, Hanoi, Vietnam
| | | |
Collapse
|