Eur J Cardiothorac Surg 2007;32:536. doi:10.1016/j.ejcts.2007.04.041
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved
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Lymphangiography in recurrent spontaneous chylothorax
Venanzio Porziellaa,
Alfredo Cesarioa,b,*,
Stefano Margaritoraa,
Pierluigi Granonea
a Division of General Thoracic Surgery, Catholic University, Rome, Italy
b Department of Internal Medicine, IRCCS San Raffaele, Rome, Italy
Received 8 February 2007;
received in revised form 19 March 2007;
accepted 2 April 2007.
* Corresponding author. Address: Division of General Thoracic Surgery, Catholic University, Largo A. Gemelli 8, 00168 Rome, Italy. Tel.: +39 03358366161; fax: +39 063051162. (Email: alfcesario{at}yahoo.com).
Key Words: Chylothorax • Diagnosis • Video-assisted thoracic surgery (VATS)
We have recently been involved in an interesting discussion related to the pre-operative assessment of spontaneous (SC) and post-traumatic chylothorax (PTC) on the journal's pages. We herein report an image (Fig. 1
) which clearly underlines the usefulness of pre-operative lymphangiography in recurrent SC and further supports our thesis as discussed.
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Fig. 1. Recurrent spontaneous chylothorax in a 56-year-old man with previous history of non-Hodgkin lymphoma (treated by chemotherapy and radiotherapy 13 years before with no signs of recurrent neoplastic disease): pre-operative lymphangiography (standard method). Lower box (paradiaphragmatic): metallic clips from the first operation. Upper box (para-mediastinal): additional chylous leak source not dealt with at the time of primary surgery, performed without pre-operative lymphangiographic assessment. A repeat right-sided video-assisted procedure with a 4 cm long ‘service’ thoracotomy (to deal with the multiple adherences from the previous operation) was performed after a fat ‘milk and butter’ meal and all the evident chylous leaks have been ‘clipped’.
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