Cyanoacrylate Embolization for Idiopathic Chylothorax
Idiopathic chylothorax is a frustrating disease to manage in which the pleural space fills with a chylous effusion resulting in dyspnea and sclerosing pleuritis over time if left untreated. Numerous surgical techniques have been described with varying success and invasiveness. Recently, thoracoscopic treatment has been described.19 Another less commonly considered technique is that used in humans which involves glue embolization of the thoracic duct using cyanoacrylate. This technique has been evaluated experimentally in animals20 as well as in a small number of clinical patients. This technique is performed under fluoroscopic guidance through an abdominal approach and involves performing lymphangiography with subsequent glue embolization of the cisterna chyli and thoracic duct. Glue embolization may be a viable primary therapy or follow-up treatment if a previous surgical attempt has failed (Figure 6).
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| Figure 6. Thoracic duct glue embolization for idiopathic chylothorax. (A) Contrast lymphangiogram through 22 gauge catheter surgically placed into efferent mesenteric lymphatic vessel demonstrating lymphatics, cisterna chyli and thoracic duct. (B) Radiograph post-glue embolization demonstrating thoracic duct branches filled with cyanoacrylate glue. Notice the many individual branches filled with this liquid mixture. |