Radiology Case Reports (Sep 2023)

Thoracic duct stent treatment for chyle leak after nephrectomy

  • Le Hoan, MD, PhD,
  • Nguyen Ngoc Cuong, PhD, MD,
  • Thieu Thi Tra My, MD,
  • Doan Tien Luu, MD, PhD,
  • Hoang Long, Prof.,
  • Tran Quoc Hoa, MD, PhD,
  • Nguyen Hoang, MD, PhD,
  • Nguyen Cong Hoan, Prof.

Journal volume & issue
Vol. 18, no. 9
pp. 3199 – 3202

Abstract

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Chyle leak is a rare and serious condition caused by damaged lymphatic vessels. It can occur after retroperitoneal surgery involving extensive lymphadenectomy for kidney cancer. Besides lymphatic channel damage, the obstruction of the thoracic duct worsens the leakage. Managing patients with thoracic duct obstruction and postsurgical chyle leakage is challenging due to limited data on how to handle this condition. In this case report, a 28-year-old female patient underwent left nephrectomy for left kidney cancer. Three days after the surgery, milky fluid drained from the left renal fossa. Conservative treatment failed, and further examination through magnetic resonance lymphangiography revealed the absence of the thoracic duct and contrast extravasation at the left renal fossa. Lymphangiography confirmed distal thoracic duct obstruction. The patient's condition was successfully managed by using thoracic duct stenting.This report contributes to the understanding that thoracic duct obstruction can lead to lymphatic collateral circulation within the abdomen, thereby increasing the risk of postoperative chylous leak.

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