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Interventional Therapies for Thoracic Duct Injury and Intractable Chylothorax

Novelli, Paula M. MD*; Chan, Ernest G. MD; Frazier, Aletta A. MD; Villa Sanchez, Manuel MD

doi: 10.1097/RTI.0000000000000422
Symposium: Imaging of Innovative and Contemporary Thoracic Interventions: State-of-the-Art

Injury to the thoracic duct with resultant chylothorax can cause significant patient morbidity and mortality. Conservative treatment strategies often fail to address the problem. Open surgical and percutaneous approaches are often required to manage patients with refractory chylothorax. This review describes in detail the major role of minimally invasive interventional therapies for thoracic duct (TD) injury. The review emphasizes strategies for identifying the TD on preprocedural imaging and describes various techniques for percutaneous access to the TD. The advantages and disadvantages of several approaches for accessing the duct are discussed. The technique of duct embolization is highlighted. The role of the minimally invasive percutaneous approach over open surgical approaches is discussed with a review of clinical outcomes, as reported in the literature. This review will also briefly discuss the surgical approach to TD ligation.

Departments of *Radiology

Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA

Department of Radiology, University of Maryland School of Medicine, Baltimore, MD

The authors declare no conflicts of interest.

Correspondence to: Paula M. Novelli, MD, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213 (e-mail:

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