• 핵의학기술
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• 제28권1호
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• pp.13-17
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• 2024

Bone Mineral Densitometry (BMD) values is determined numerically with T or Z-score while the image is not considered in the interpretation. Abnormal finding was observed in the left femoral bone density image of a 64-year-old female patient who underwent a left kidney transplantation. This was due to the ethiodized oil used for embolization in the treatment of lymphatic leakage. Radiologic technologists should not only monitor changes of BMD values, but keep in mind to assess the changes in the image to provide accurate information to the patient.

• Journal of Chest Surgery
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• 제53권4호
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• pp.191-199
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• 2020

Surgeons recommend dissecting lymph nodes in the thorax, abdomen, and neck during surgery for esophageal cancer because of the possibility of metastasis to the lymph nodes in those areas through the lymphatic plexus of the esophageal submucosal layer. Extensive lymph node dissection is essential for accurate staging and is thought to improve survival. However, it can result in several complications, including chyle leakage, which refers to continuous lymphatic fluid leakage and can occur in the thorax, abdomen, and neck. Malnutrition, fluid imbalance, and immune compromise may result from chyle leakage, which can be potentially life-threatening if it persists. Therefore, various treatment methods, including conservative treatment, pharmacological treatment such as octreotide infusion, and interventions such as thoracic duct embolization and surgical thoracic duct ligation, have been applied. In this article, the risk factors, diagnosis, and treatment methods of chyle leakage after esophagectomy are reviewed.

• Archives of Plastic Surgery
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• 제49권2호
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• pp.227-239
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• 2022

Complications experienced during lymphatic surgery have not been ubiquitously reported, and little has been described regarding how to prevent them. We present a review of complications reported during the surgical management of lymphedema and our experience with technical considerations to reduce morbidity from lymphatic surgery. A comprehensive search across different databases was conducted through November 2020. Based on the complications identified, we discussed the best approach for reducing the incidence of complications during lymphatic surgery based on our experience. The most common complications reported following lymphovenous anastomosis were re-exploration of the anastomosis, venous reflux, and surgical site infection. The most common complications using groin vascularized lymph node transfer (VLNT), submental VLNT, lateral thoracic VLNT, and supraclavicular VLNT included delayed wound healing, seroma and hematoma formation, lymphatic fluid leakage, iatrogenic lymphedema, soft-tissue infection, venous congestion, marginal nerve pseudoparalysis, and partial flap loss. Regarding intra-abdominal lymph node flaps, incisional hernia, hematoma, lymphatic fluid leakage, and postoperative ileus were commonly reported. Following suction-assisted lipectomy, significant blood loss and transient paresthesia were frequently reported. The reported complications of excisional procedures included soft-tissue infections, seroma and hematoma formation, skin-graft loss, significant blood loss, and minor skin flap necrosis. Evidently, lymphedema continues to represent a challenging condition; however, thorough patient selection, compliance with physiotherapy, and an experienced surgeon with adequate understanding of the lymphatic system can help maximize the safety of lymphatic surgery.

• Korean Journal of Radiology
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• 제25권1호
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• pp.55-61
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• 2024

Objective: This study aimed to evaluate the safety and efficacy of intranodal lymphangiography and thoracic duct embolization (TDE) for chyle leakage (CL) after thyroid surgery. Materials and Methods: Fourteen patients who underwent intranodal lymphangiography and TDE for CL after thyroid surgery were included in this retrospective study. Among the 14 patients, 13 underwent bilateral total thyroidectomy with neck dissection (central compartment neck dissection [CCND], n = 13; left modified radical neck dissection (MRND), n = 11; bilateral MRND, n = 2), and one patient underwent left hemithyroidectomy with CCND. Ten patients (76.9%) had high-output CL (> 500 mL/d). Before the procedure, surgical intervention was attempted in three patients (thoracic duct ligation, n = 1; lymphatic leakage site ligation, n = 2). Lymphangiographic findings, technical and clinical successes, and complications were analyzed. Technical success was defined as the successful embolization of the thoracic duct after access to the lymphatic duct via the transabdominal route. Clinical success was defined as the resolution of CL or surgical drain removal. Results: On lymphangiography, ethiodized oil leakage near the surgical bed was identified in 12 of 14 patients (85.7%). The technical success rate of TDE was 78.6% (11/14). Transabdominal antegrade access was not feasible due to the inability to visualize the identifiable cisterna chyli or a prominent lumbar lymphatic duct. Among patients who underwent a technically successful TDE, the clinical success rate was 90.1% (10/11). The median time from the procedure to drain removal was 3 days (with a range of 1-13 days) for the 13 patients who underwent surgical drainage. No CL recurrence was observed during the follow-up period (ranging from 2-44 months; median, 8 months). There were no complications, except for one case of chylothorax that developed after TDE. Conclusion: TDE appears to be a safe and effective minimally invasive treatment option for CL after thyroid surgery, with acceptable technical and clinical success rates.

• 대한영상의학회지
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• 제81권5호
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• pp.1222-1226
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• 2020

림프종은 비외상성 유미흉의 원인 중 높은 빈도를 차지한다. 문헌에 따르면 비외상성 유미흉에 대해서 흉관 색전술을 시행할 경우 외상성 유미흉의 경우에 비해 치료성적이 낮은 것으로 알려져 있다. 이 논문에서는 비외상성 유미흉이 있던 림프종 환자에서 흉관 색전술을 시행하고, 추가적으로 피부경유 종양 직접 천자 색전술을 시행하여 좋은 결과를 얻었기에 이에 대한 증례를 보고하고자 한다. 본 증례는 77세 남자 환자로 림프종에 동반된 유미흉을 치료하기 위해 흉관 색전술을 시행 받았고 그 후 유미흉의 양이 줄어들었으나 지속되는 흉막삼출을 호소하였다. 이에 피부경유로 폐를 침범한 림프종을 직접 천자하여 이차 색전술을 시행하였고, 이후 흉막삼출이 호전되어 성공적으로 흉관을 제거하였다. 이 시술은 림프종과 동반된 유미흉이 있는 경우에 시행할 수 있는 새로운 치료 선택지라 할 수 있다.

• Journal of Chest Surgery
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• 제37권12호
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• pp.1029-1031
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• 2004

림프관평활근종증은 드문 질환이며, 임상경과상 악성으로 분류할 수 있다. 복통을 주소로 입원한 21세 여자 환자가 골반 내시경을 통해 난소 황체 출혈을 지혈하였고, 그 후 유미성 복수로 개복하여 후 복막에 위치한 낭성 종양을 절제하여 림프관평활근종증으로 조직 진단 받았다. 홀몬 치료 중 유미흉이 발생하여 흉부외과에서 개흉하여 림프액 누출부위를 봉합결찰하였고, 10% 포타딘 관주로 유미흉은 호전되었으나 유미성 복수가 재발하였으며 진단 6개월에 전신 쇠약과 호흡 부전으로 사망하였다.

• Investigative Magnetic Resonance Imaging
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• 제22권3호
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• pp.182-186
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• 2018

Dynamic enhanced magnetic resonance lymphangiography can be used to provide anatomic and dynamic information for various lymphatic diseases, including thoracic duct injury, and can also help to guide the thoracic duct embolization procedure. We present a case of postoperative chylothorax demonstrated by dynamic enhanced MR lymphangiography. In this case, the chyle leakage site and location of cisterna chyli were clearly visualized by dynamic enhanced MR lymphangiography, thus allowing for management with thoracic duct embolization.

• Journal of Chest Surgery
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• 제54권4호
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• pp.325-329
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• 2021

Chylothorax is caused by lymphatic leakage, which can develop after thoracic surgery and is associated with cancer. Although prospective randomized trials have not been performed, radiological interventions have been performed in several cases with persistent chylothorax, adjunct to 2 weeks of conservative management. The success rate of such interventions is diverse due to anatomical variations, although the results are promising. However, in cases of treatment failure after cycles of interventions, a team approach may be necessary to determine whether surgical management is warranted.

• Archives of Plastic Surgery
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• 제38권3호
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• pp.329-332
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• 2011

Purpose: In developed countries, vesicovaginal fistula occur from various pelvic operations including total hysterectomy, leading to urinary leakage and incontinence. Although various methods have been proposed for adequate tissue coverage in fistula repair, the surgical treatment of is not simple and still controversial. We report a case of neobladder-vaginal fistula repair using modified Martius fat pad flap. Methods: A 62-year-old female patient underwent radical cystectomy with total abdominal hysterectomy and neobladder formation due to invasive bladder tumor 5 years ago. For 3 years following the operation, urine leakage was observed. Exploration demonstrated neobladder-vaginal fistula and primary repair including fistulectomy and direct closure was performed. Urinary incontinence relapsed 2 years after primary repair, and after demonstrating the recurrence of fistula on urography, repair of recurrent fistula was performed. After dissection of vagina and neobladder and closure of fistula by urologic surgeon, fibroadipose flap was elevated, rotated and advanced through the tunnel at vaginal sidewall, and interpositioned to the fistula site between neobladder and vagina. Results: There was no acute complication after the surgery and urethral catheter was extracted on the 8th day after the operation. During six month follow-up period after the operation, there is no clinical evidence of fistula recurrence. Conclusion: From our clinical experience and literature review, we think Martius fat pad flap is a useful technique in management of neobladder-vaginal fistula, for it provides enough vascularity, major epithelization surface and better lymphatic drainage, and also prevents overlapping of vesical, vaginal suture lines at the same time.

• 한국임상수의학회지
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• 제35권6호
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• pp.290-293
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• 2018

Signalment: A dog which had been hit by car a month prior and had been experiencing recurrent pleural chyle effusion was referred to Chung-buk National University Animal Medical Center. The clinical signs included tachypnea and salivation. Results: Ultrasound-guided popliteal lymphography was performed. The computed tomography imaging revealed that the thoracic duct was ruptured and the lymph was leaking into the cranial mediastinal region. After this discovery, thoracic duct ligation was performed. The ultrasound-guided popliteal lymphography was repeated after the surgery. The second computed tomography imaging revealed that the thoracic duct rupture was resolved. Clinical relevance: We identified the etiology of chylothorax through the computed tomographic lymphography and imaged specific leakage areas. After surgery, the computed tomography imgaing confirmed the lymphatic flow modification and the treatment was successful.