PMC8214886_01
Thoracic and abdominal enhanced computed tomography. A - axial plane and B coronal plane - images at admission showing a cystic image (black arrow) in the thoracic duct site at the thoracic-abdominal transition, well-defined and without enhancement in contact with the aorta (black asterisk), and associated with ascites (white asterisks), C - sagittal plane and D axial plane showing ascites (white asterisks) and bilateral laminar pleural effusion, as well as the bladder (#) and the uterus (black asterisk).
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CA 19.9, CA 72.4, and CEA were normal, but CA 125 (>= 35): 330.6 U/mL. Contrast-enhanced abdominal computed tomography (CT) showed a well-delimited cystic image without enhancement, located in the topography of the thoracic duct in the thoracoabdominal transition and in contact with the aorta, associated with massive ascites and mild bilateral pleural effusion (Figures 1).
Axial MRI sections of the chest showing a cystic image in the topography of the thoracic duct (arrow) characterized by A - a low signal in the T1-weighted sequence; B - a high signal in the T2-weighted sequence; associated with C - small pleural effusion and ascites (asterisks); the cyst is also evident (arrow) in the coronal section on the T2-weighted sequence, and D - without enhancement in the T1-weighted sequence after contrast injection.
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Magnetic resonance imaging (MRI) of the chest with contrast revealed a cystic image at the thoracoabdominal transition, in the topography of the thoracic duct on the right of the aorta, measuring 4.0 cm x 3.8 cm x 2.2 cm, with homogeneous content and lobulated contours in the upper portion (Figure 2).
Gross view of the milky-like liquid collected on the drainage of the ascites.
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The patient underwent exploratory laparotomy through a Pfannenstiel incision, and approximately one liter of liquid with a milky aspect was drained (Figure 3), and a tubule-laminar drain was placed in the cavity.
Contrast-enhanced CT scan of the abdomen after drainage, A - shows a significant reduction in ascites (white asterisk) and partially drainage (arrow) in the sagittal plane, in addition to the uterus (black asterisk) and the bladder (#); B - the coronal section image, confirms the total regression of ascites detected in the admission exam; C and D - Contrast-enhanced chest CT scan after drainage, C - axial section, and mediastinal window shows the close relationship between the cyst and the thoracic duct (black asterisk) and other structures such as the descending aorta (#), the azygous vein (white asterisk) and the esophagus (arrowhead); it also reveals the absence of pleural effusion; D - sagittal section shows the major diameter of the cyst at the site of the thoracic duct (long arrow), its location in the posterior mediastinum and the relationship with the esophagus (short arrow), the right ventricle (black asterisk), and the azygous vein (white asterisk).
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There was a decrease in daily ascitic output in abdominal and chest fluid by CT control images (Figure 4), and clinical improvement.