Lymphatic Interventions

Thoracic duct embolization (TDE) is performed to treat accumulation of lymphatic or chylous fluid in the pleural or pericardial space originating from a traumatic or non-traumatic in etiology. Traumatic, often post-surgical, chylothorax can be treated by use of intranodal lymphangiography and TDE with platinum-based coils and n-butyl cyanoacrylate (n-BCA) glue with both a high degree of clinical success and low incidence of complications. As the etiology and site of leaks from non-traumatic chylothorax can vary and be difficult to identify on fluoroscopy, advanced lymphatic imaging using MR lymphangiography can guide the treatment plan as the thoracic duct or its branches may not be the sole source of the chylous leak in these instances. Similarly, TDE can be an effective method to treat plastic bronchitis, a condition in which the pulmonary lymphatics have retrograde flow into the lung parenchyma resulting in the development of chyle casts in the airway. In the subsequent chapter, we will review the pathophysiology of chylothorax and plastic bronchitis as well as the imaging and treatment methods for these conditions.