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Therapeutic efficacy of lipiodol in patients of chylothorax and chylous ascites with no demonstrable leak by fluoroscopic intranodal lymphangiogram

Kalpana Radhakrishnan, Thangalakshmi Adaikkalam, Karthik Palanisamy, Gayathri Shanmugam.

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Introduction: Lymphatic leakage is a rare but severe complication that can occur after various surgical procedures, traumatic injury, and unknown etiology. Lymphangiography using lipiodol is a useful diagnostic tool and also has the therapeutic advantage of occluding small leaks by its sclerosing property. In our study, we evaluated the therapeutic efficacy of lipiodol used in lymphangiogram in patients with no demonstrable post lymphangiogram leak in fluoroscopic intranodal lymph angiogram. This study was done at Barnard Institute of Radiology, Madras medical college, Chennai, Tamilnadu with the data between January 2020 to August 2021.
Case series: Seven Patients with idiopathic intractable chylous ascites and chylothorax were quantified using ultrasonogram and then subjected to fluoroscopic intranodal lipiodol lymphangiogram. Five patients with no demonstrable leak were followed up. Among five patients in our study, there was a 80 – 90 % reduction of chylothorax in two patients, a 50 – 60 % reduction of chylothorax in two patients, and a 20 – 30 % reduction of chylous ascites in one patient.
Conclusion: Intranodal fluoroscopic lymphangiogram is a valuable tool in imaging the lymphatics and detecting the congenital abnormality or post-traumatic leak as a cause for chylous ascites/chylothorax. In our study, it is proven that lipiodol has a therapeutic effect on patients having a small leak.

Key words: chylothorax, chylous ascites, lymphangiogram, lntranodal lipiodol

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