Computed Tomographic Lymphography of the Thoracic Duct by Mesenteric Lymph Node Injection

Authors

  • ERIC G. JOHNSON DVM, Diplomate ACVR,

    1. Departments of Surgical and Radiological Sciences and Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA
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  • ERIK R. WISNER DVM, Diplomate ACVR,

    1. Departments of Surgical and Radiological Sciences and Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA
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  • ANDREW KYLES BVMS, PhD, Diplomate ACVS,

    1. Departments of Surgical and Radiological Sciences and Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA
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  • CARL KOEHLER DVM, Diplomate ACVS,

    1. Departments of Surgical and Radiological Sciences and Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA
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  • STANLEY L. MARKS BVSc, PhD, Diplomate ACVIM (Internal Medicine, Oncology), Diplomate ACVN

    1. Departments of Surgical and Radiological Sciences and Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA
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  • Presented in part at the 2005 annual conference of the American College of Veterinary Radiology, Chicago, IL, November 29–December 3, 2005.

Address reprint requests to Eric G. Johnson, DVM, Diplomate AVCR, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, 2112 Tupper Hall, University of California—Davis, Davis, CA 95616. E-mail: egjohnson@ucdavis.edu.

Abstract

Objective— To document a novel technique to image the thoracic duct and its tributaries by contrast enhanced computed tomography (CT) lymphography.

Study Design— Clinical report.

Animals— Dogs (n=6) idiopathic chylothorax.

Methods— Ultrasonography was used to guide percutaneous injection of intestinal lymph nodes with nonionic iodinated contrast medium for preoperative CT lymphography of the thoracic duct in 6 dogs with chylothorax. Thoracic CT images were acquired immediately after contrast medium injection. All dogs had subtotal pericardectomy and thoracic duct ligation. Postoperative thoracic duct lymphography was performed in 3 dogs. Superficial cervical lymph node lymphography was performed in 2 dogs to determine cervical lymphatic contribution to thoracic effusions.

Results— Preoperative thoracic duct lymphography using this technique was successful in delineating the cisterna chyli, thoracic duct, and associated lymphatic vessels in all dogs. Immediate postoperative lymphography performed in 2 dogs revealed successful duct ligation in 1 dog and persistent lymphatic leakage in the other. A 1-month postoperative thoracic duct lymphogram performed in 1 dog revealed unsuccessful ligation or recannulation of 1 of 3 redundant vessels seen preoperatively.

Conclusion— Percutaneous CT lymphography results in excellent detection of the thoracic duct and abnormal thoracic duct drainage patterns both pre- and postoperatively. The contribution of superficial cervical lymph node drainage to reoccurrence of effusions can be evaluated.

Clinical Relevance— Percutaneous CT lymphography using ultrasound-guided contrast medium injection should be considered as an alternative to conventional open abdominal approaches to radiographic or CT lymphography.

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