PMC8571355_01
(a and b) A 68-year-old male with abdominal pain and distension after radical nephrectomy diagnosed with chylous ascites. Two Axial CT images revealing large volume abdominal chylous ascites.
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F1
CT scan showed large volume abdominopelvic ascites believed to be chylous in origin [Figure 1].
Ultrasound image of the right groin showing a normal lymph node (white arrowheads) being accessed using a 21-gauge needle (white arrow) for the purposes of the lymphangiogram.
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F2
Bilateral inguinal lymph nodes were identified and accessed with 21-gauge needles using ultrasound guidance [Figure 2] (Philips, EPIQ 7, Netherlands).
(a) Single spot image of the pelvis following Lipiodol injection into the groin lymph node showing pelvic lymphatics (black arrows). (b) Spot image of the abdomen showing a linear radio-opacity in the left upper quadrant corresponding to the area of lymph node dissection with chylous leak (white arrow).
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F3
Opacification of the lymphatic channels in the retroperitoneum [Figure 3a] was confirmed with serial spot radiographic images. Active extravasation from a small lymphatic channel overlying the left psoas muscle was identified after approximately 1 h of the injection [Figure 3b].
Coronal reconstruction Cone-beam CT obtained during the lymphangiogram confirming the leak (white arrow) in the left paravertebral region.
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F4
This was confirmed by cone-beam CT [Figure 4] (Siemens Artis Zee, Erlangen, Germany).
CT guidance for glue injection (white arrow) into the focal area of chyle leak identified by the lymphangiogram.
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F5
Once CT confirmed appropriate needle location, 4 cc of 1:1 mixture of n-butyl cyanoacrylate (Cordis Neurovascular, Inc., Miami Lakes, FL) and Lipiodol was injected into the focal leak [Figure 5].
Axial contrast-enhanced CT of the abdomen following glue embolization shows retention of glue (white arrow) in the area of the focal chyle leak. Note the complete resolution of ascites.
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F6
Follow-up CT 1 month later showed complete resolution of ascites and persistent glue cast in the localized leak in the retroperitoneum [Figure 6].