A Case of Embolization of a Lymphatic Malformation Complicated by Chylothorax, Chylopericardium, and Interstitial Lung Disease in a 6-Year-Old Pediatric Patient.

Abstract

Background: A 6-year-old child with a clinical history of chylopericardium treated with pericardiocentesis presented with retrosternal chest pain and asthenia in the past 2-3 days. The patient underwent a chest-abdominal MRI revealing pericardial and pleural effusion with lymphatic malformation of the thoracic duct and lymphatic abdominal vessels.

Materials and methods: The patient underwent a thoracic duct embolization, consisting of two stages. At the first stage, a US-guided catheterization of a hepatic lymphatic duct and of two inguinal lymph nodes bilaterally was carried out to perform a dynamic contrast-enhanced MR intranodal lymphangiography (DCMRL). DCMRL showed lymphangiectasia of retroperitoneal lymphatics and of the thoracic duct with double drainage into the left subclavian vein and a possible lymphatic leak near the pulmonary veins. At a second stage, a thoracic duct catheterization and lymphography were performed, confirming the lymphatic leakage into the pericardial cavity and allowing the embolization of the thoracic duct extending to L1 vertebral level through pushable and detachable coils followed by injection of cyanoacrylate diluted 1:1 with lipiodol.

Conclusion: This case was emblematic as it underlined the importance of DCMRL as a preprocedural diagnostic tool for studying lymphatic variants and malformations of patients needing any lymphatic treatment. It also added evidence on the effectiveness of this interventional approach for treating chylous effusions and interstitial lung disease.