[Intranodal lymphangiography in pediatric chylothorax, a diagnostic and therapeutic tool].

INTRODUCTION: High morbidity has been described in secondary chylothorax. Thoracic duct embolization (TDE) after intranodal lymphangiography (IL) is one of the treatments in adults but there is poor experience in children. We aim to describe our experience with this technique for refractory pediatric chylothorax.

METHODS: A retrospective study of patients with refractory chylothorax treated with thoracic duct embolization at our Institution in the last 4 years was performed. Lymphatic vessels visualization was obtained by intranodal lymphangiography with ethiodized oil. Demographic and clinical data as well as imaging findings were collected.

RESULTS: A total of 4 patients were treated during the study period with a median of age and weight of 2.5 months (1-16) and 4.25 kg (2.8-10) respectively. Chylothorax was secondary to cardiothoracic surgery in 3 patients and to venous thrombosis in the other one. Medical treatment was provided during a median of 47 days (13-56) without benefit in thoracic output [median: 46 ml/kg/day (19-64)]. After IL, thoracic duct catheterization was achieved in one patient however embolization was not possible. Chylothorax stopped in the 3 post-surgical patients regardless of how much lymphatic visualization was achieved in IL. In the venous thrombosis patient surgical treatment was performed 6 days after the study.

CONCLUSION: IL can be a diagnostic and therapeutic tool in children. Ethiodized oil seems to seal lymphatic leak in postsurgical chylothorax. IL could be an option for chylothorax in patients too sick for surgical treatment or in whom thoracic duct embolization is not feasible.