Percutaneous Lymphatic Embolization for Chylothorax Secondary to Gorham-Stout Disease.

Abstract

Objective: To assess the role and treatment response of percutaneous lymphatic embolization performed for non-traumatic chylothorax in patients with Gorham-Stout disease (GSD) with regard to thoracic duct embolization (TDE) and embolization of pleural or lymphatic collaterals.

Materials and methods: This retrospective single-institution study included consecutive patients who underwent percutaneous lymphatic embolization between January 2013 and December 2022. The patients underwent dynamic contrast-enhanced magnetic resonance lymphangiography, fluoroscopic intranodal lymphangiography, or both to evaluate the lymphatic anatomy prior to the intervention. The patients underwent TDE, pleural lymphatic embolization, or both, depending on the imaging findings. The data collected included imaging findings, procedural details, and clinical outcomes (clinical success was defined as removal of the drainage catheter without re-accumulation of effusion or improvement in clinical symptoms).

Results: Five male patients (aged 5-29 years) with chylothorax (n = 3) or hemorrhagic chylothorax (n = 2) were included. The key imaging findings included giant thoracic duct (n = 3) and dilated parietal pleural lymphatic system (n = 5). Twelve embolization sessions were performed (median, 2 sessions per patient; range 1-4 sessions). The embolized lymphatic structures included the thoracic duct (n = 4), parietal pleural lymphatics (n = 4), and other lymphatic collaterals (n = 3). The embolic agents used were glue and coils (n = 3), and glue only (n = 2). TDE alone achieved clinical success in only 25% of the cases (1 out of 4). With additional embolization of the parietal pleural lymphatics and other collaterals, clinical success was achieved in 80% of the cases (4 out of 5). One patient developed chylous ascites after the TDE.

Conclusion: Percutaneous lymphatic embolization targeting the thoracic duct and pleural lymphatic collaterals is a feasible treatment option for GSD-related chylothorax.