A Case of Lymphangiography for Postoperative Chylothorax Resistant to Thoracic Duct Ligation

Abstract

Chylothorax is a common complication of thoracic surgery for lung cancer. It occurs after surgery for lung cancer and accounts for 1.2% - 3.0% of all complications. Generally, fasting, total parenteral nutrition (TPN), and thoracic duct ligation are the main treatments. Recently, it has been reported that lymphangiography is effective for postoperative chylothorax. We encountered a case, where lymphangiography was effective for chylothorax after lobectomy, which did not respond to thoracic duct ligation. A 40-year-old woman was diagnosed with lung cancer (cT4N0M0 : cStage IIIA), and underwent left upper lobectomy with phrenic and vagus nerve resection. On the second day following the operation, an infiltrative shadow was observed in the total left lung field. Drainage fluid from the chest tube appeared cloudy ; chylothorax was diagnosed and treatment for this complication was initiated on the third day. However, conservative treatment and thoracic duct ligation could not resolve the chylothorax, and lymphangiography by inguinal lymph node puncture was administered on the 30th postoperative day. On the next day, the drainage fluid appeared serous and chylothorax was resolved. Lymphangiography is considered effective for chylothorax resistant to conservative and surgical treatments, though it can be done in limited institutions.