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• W2040962802 abstract "Purpose To study the feasibility of C-arm CTL following ultrasound guided inguinal lymph node injection of water soluble contrast media in children with right to left shunts. Materials and Methods Patient 1 : A 4 year old boy with complex congenital heart disease developed recurrent right sided chylothorax which resolved followed by left chylothorax requiring several chest tubes. A lymphangiogram was performed to look for thoracic duct leak. Patient 2 : A 13 year old girl with multiple cutaneous epidermal nevi, simple renal and splenic cysts, multiple lytic bone lesions, bilateral interstitial lung disease, multiple left lower lobe pulmonary AVM’s developed recurrent chylopericardium. This was managed with pericardial drainage and lymphangiogram was performed to look for leak. Technique : Lipiodol could not be used due to the risk of systemic embolization in the presence of right to left shunts. Under ultrasound guidance bilateral inguinal nodes were accessed using 25G needles followed by slow hand injection of Optiray 320. 2D-fluoroscopic visualization of the pelvic and lumbar lymphatics up to L2 level was possible beyond which dilution of contrast from leakage across the wall of the lymphatics precluded visualization. C-arm CT (syngo Dyna CT®, Siemens Medical Solutions USA Inc.) of the chest was performed using 8s DR-body protocol and images were reconstructed. Results Patient 1 : C-arm CTL showed a lobulated pseudoaneurysm of the thoracic duct at the level of T6 adjacent to a surgical clip with normal course and caliber of the rest of the duct to its insertion into the left subclavian vein and no leak. Patient 2 : C-arm CTL showed reflux of contrast into dilated lymphatics in the mediastinum, left hilum and left lower lobe suggestive of lymphangiectasia with uninterrupted course of the rest of the duct to the left subclavian vein. No leak into the pericardium was seen but the study was limited by artifacts from pericardial drainage catheter and nasogastric tube. Conclusion C-arm CTL can successfully demonstrate thoracic duct anatomy and pathology in combination with ultrasound guided inguinal nodal injection of water soluble contrast agent in children with contraindication for oily contrast media." @default.
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• W2040962802 date "2013-04-01" @default.
• W2040962802 modified "2023-09-27" @default.
• W2040962802 title "Imaging of the thoracic duct using C-arm CT lymphangiography (CTL) following ultrasound guided inguinal nodal injection in children with right to left shunts" @default.
• W2040962802 doi "https://doi.org/10.1016/j.jvir.2013.01.065" @default.
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