Pressurized Contrast Injection in a Lymphocele Can Reveal an Embolizable Lymphopseudoaneurysm in Postsurgical Chylous Ascites.

Abstract

This report describes the technique of lymphopseudoaneurysm (LPA) detection by pressurized contrast injection into a lymphocele, followed by image-guided embolization. A 37-year-old man with pancreatic neuro-endocrine tumor, portal cavernoma, and liver metastasis underwent pancreaticoduodenectomy, right hepatectomy, lymphadenectomy, and left portal vein reconstruction. Postoperative course was complicated by refractory chylous ascites. Computed Tomography (CT) revealed a centrally located lymphocele in the abdominal cavity. Direct puncture of the lymphocele, followed by pressurized contrast injection revealed a tubular connection to a smaller retroperitoneal collection near the surgical site, which was considered to be the culprit LPA. After catheter directed embolization of this LPA with N-butyl-cyanoacrylate glue, chylous ascites ceased and abdominal drainage catheters were removed 12 days later.