A Case of Chylothorax after Radical Surgery for Esophageal Cancer Cured by Lipiodol Lymphangiography

Mamoru Uemura, Yuichiro Doki, Osamu Ishikawa, Jun Ueda*, Kouichi Yoshikawa**, Masato Morimoto**, Ko Takachi, Isao Miyashiro and Shingi Imaoka

Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
Department of Radiology* and Department of Thoracic Surgery**, Sumitomo Hospital

A 57-year-old man undergoing radical surgery for advanced esophageal cancer (cT3N1M1lym), including subtotal esophagectomy, reconstruction with a posterior mediastinal gastric tube, and dissection of standard 2-field and abdominal paraaortic lymph nodes. Suffered chylothorax with pleural effusion of approximate 800 ml/day when started on oral foods intake. Chylothorax was treated with: (1) starvation and total parental nutrition on postoperative day (POD) 14-34, (2) ligation of the thoracic duct via right thoracotomy on POD 35, (3) pleurodesis with OK-432 and minomycin on POD 38-49 and (4) artificial tube shunting from the thoracic cavity to the subclavicular vein and abdominal cavity on POD 64, but, all to no effect. The site of lymphatic leakage could not be identified by lymph scintigraphy. Lymphangiography was done using 15 ml of lipiodol on POD 121. Although the site of leakage was never determined, pleural effusions drainage decreased immediately and completely stopped 8 days after lymphangiography. Lymphangiography using lipiodol helps determine the site of chyle leakage and may be an effective therapeutic modality for treating chylothorax untreatable conventionally.

Key words
esophageal cancer, chylothorax, lymphangiography

Reprint requests
Yuichiro Doki Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511 JAPAN

Accepted
July 28, 2004

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