PMC5155138_01
Computed tomograph (CT)-generated lymphography of the thoracic duct prior to surgery. Imaging was performed using a multi-detector helical CT scanner 10 min after iopamidol injection into the subcutaneous tissue around the anus. (A) The lymphatic duct was identifiable in both the thoracic and abdominal cavities in the sagittal plane. The contrast agent blurred around the mediastinal lymph nodes (ellipse), indicating a leak into the thoracic cavity. (B) In the transverse plane at the eighth thoracic vertebra, a lymphatic duct (arrow) passing between the aorta (Ao) and azygos vein (asterisk) could be identified.
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Tochigi, Ootawara, Japan) at 2, 8, 10 and 15 min after the injection. The timing of the scanning was also changed from the original study (Ando et al., 2012). The contrast medium reached the mediastinal lymph nodes at 10 min after injection and leakage of the contrast agent was detected at the anterior mediastinal lesion (Fig. 1).
Lymphography 7 days after thoracic duct ligation. Computed tomography imaging was performed 15 min after iopamidol injection into the subcutaneous tissue around the anus. (A) In the sagittal plane, the vascular clips used to ligate the thoracic duct during the first surgery can be seen (arrowheads). Thoracic tracts cranial to the vascular clips were also observed, indicating the incomplete blockade of lymph flow (arrows). (B) In the coronal plane, the collateral lymphatic duct (arrows) passing through the left side of the vascular clips (arrowheads) could be identified near the eighth vertebra.
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However, a collateral thoracic duct running along the left-hand side of the ligated duct was found (Fig. 2).