Ultrasound-guided intranodal lymphangiography followed by thoracic duct embolization for treatment of postoperative bilateral chylothorax

Background Percutaneous thoracic duct embolization (TDE) is a safe, effective, and minimally invasive option for treating chylothorax. A recent report demonstrated the feasibility of ultrasound-guided intranodal lymphangiography as an alternative to pedal lymphangiography for visualization of the thoracic duct, promising relative technical ease and decreased procedure time for TDE. Methods We report a case of postoperative bilateral chylothorax treated with ultrasound-guided intranodal lymphangiography followed by TDE. Results Intranodal lymphangiography resulted in rapid opacification of the abdominal lymphatics, permitting technically successful primary and secondary embolization procedures. Deployment of metallic coils and liquid embolic agents within the thoracic duct produced rapid clinical and radiographic improvement. Conclusion Intranodal lymphangiography is a reliable, reproducible, and less technically challenging alternative to pedal lymphangiography.