PMC9115550_01
CT scan showing a uniform left massive pleural effusion.
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F1
Therefore, the patient was sent for an urgent chest computed tomography (CT) scan, which confirmed a massive homogeneous left effusion with contralateral mediastinal shifting (Figure 1).
PMC9115550_02
Ultrasound-guided inguinal lymph node administration of indocyanine green.
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F2
After general anesthesia induction, with the patient in the supine position, an ultrasound-guided inguinal lymph node injection of 10 ml saline with 0.5 mg/kg ICG solution (Infracyanine, SERB SAS, Paris, France) was bilaterally performed (Figure 2).
Left video-assisted thoracoscopic surgery (VATS) view showing fluorescent lymph spilling from the left para-aortic zone.
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F3
In Case 1, a dilated tributary of the TD was identified (Figure 3), while in Case 2, the leakage point was identified on the TD at the level of paraesophageal lymphadenectomy (Figure 4).
Right VATS view showing the thoracic duct and its leakage point in the low paraesophageal area.
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F4
In Case 1, a dilated tributary of the TD was identified (Figure 3), while in Case 2, the leakage point was identified on the TD at the level of paraesophageal lymphadenectomy (Figure 4).