Fusion imaging of single-photon emission computed tomography and magnetic resonance lymphangiography for post-Fontan chylothorax

Takashi Shima, MD, PgDip; Takuya Hara, MD; Keisuke Sato, MD; Nobuhiko Kan, MD; Tadamune Kinjo, MD, PhD

Radiology Case Reports (Apr 2023)

Fusion imaging of single-photon emission computed tomography and magnetic resonance lymphangiography for post-Fontan chylothorax

Takashi Shima, MD, PgDip,
Takuya Hara, MD,
Keisuke Sato, MD,
Nobuhiko Kan, MD,
Tadamune Kinjo, MD, PhD

Affiliations

Takashi Shima, MD, PgDip: Department of Neonatology, Fukuoka Children's Hospital, 5-1-1, Kashiiteriha, Higashiku, Fukuoka, Fukukoka, 813-0017, Japan; Department of Fetal Cardiology, Fukuoka Children's Hospital, 5-1-1, Kashiiteriha, Higashiku, Fukuoka, Fukuoka, 813-0017, Japan; Corresponding author.
Takuya Hara, MD: Department of Cardiology, Fukuoka Children's Hospital, 5-1-1, Kashiiteriha, Higashiku, Fukuoka, Fukuoka, 813-0017, Japan; Department of Pediatrics, Oita Prefectural Hospital, 2-8-1, Bunyo, Oita, Oita, 870-8511, Japan
Keisuke Sato, MD: Department of Cardiology, Shizuoka Children's Hospital, 860, Urushiyama, Aoi Ward, Shizuoka, Shizuoka, 420-8660, Japan
Nobuhiko Kan, MD: Department of Neonatology, Fukuoka Children's Hospital, 5-1-1, Kashiiteriha, Higashiku, Fukuoka, Fukukoka, 813-0017, Japan; Department of Fetal Cardiology, Fukuoka Children's Hospital, 5-1-1, Kashiiteriha, Higashiku, Fukuoka, Fukuoka, 813-0017, Japan; Department of Cardiology, Fukuoka Children's Hospital, 5-1-1, Kashiiteriha, Higashiku, Fukuoka, Fukuoka, 813-0017, Japan
Tadamune Kinjo, MD, PhD: Department of Neonatology, Fukuoka Children's Hospital, 5-1-1, Kashiiteriha, Higashiku, Fukuoka, Fukukoka, 813-0017, Japan

Journal volume & issue: Vol. 18, no. 4
pp. 1471 – 1476

Abstract

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A preschool male patient with an extensive cardiac surgical history developed refractory chylothorax after a total cavopulmonary connection. Neither lymphoscintigraphy nor single-photon emission computed tomography (SPECT)/computed tomography could identify the lymphatic system leakage sites. Non-contrast heavy T2-weighted magnetic resonance lymphangiography (MRL) was performed to visualize the lymphatic system. Nevertheless, distinguishing lymphatic ducts from other watery structures of the patient remained difficult. Therefore, non-contrast MRL and SPECT images were fused. This hybrid diagnostic tool elucidated the pathophysiology of the prolonged chylothorax; pulmonary lymphatic perfusion syndrome and illustrated the anatomical connection of the thoracic duct and an abnormally dilated lymphatic network in the neck and left hilar regions. Subsequent intranodal lymphangiography with ethiodized oil confirmed these findings. SPECT/MRL may become an alternative modality for revealing the mechanism of prolonged chylothorax by visualizing the lymphatic system when dynamic contrast-enhanced magnetic resonance lymphangiography is unavailable.

Published in Radiology Case Reports

ISSN: 1930-0433 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine
Website: https://www.sciencedirect.com/journal/radiology-case-reports

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