CTICasesIatrogenic Thoracic Duct Injury with Chylothorax
Imaging findings
A man with squamous cell carcinoma of the tongue underwent cervical lymph node biopsies (which returned benign) and sustained injury to a high-riding thoracic duct, producing a large cervical chyle leak and chylous pleural effusions. Lymphangiography over subsequent months shows the injured, ligated thoracic duct and the leak. A post-lymphangiogram chest CT shows linear hyperattenuating Lipiodol within pulmonary vessels.
Key takeaways
A high-riding thoracic duct can be injured during cervical lymph node biopsy, producing a chyle leak and chylous effusions that may require repeated lymphangiography and duct ligation. Embolized Lipiodol within pulmonary capillaries is an expected finding after lymphangiography and is usually inconsequential, but it can be problematic in patients with an intracardiac shunt because deposits can reach the brain and cause neurologic deficits or seizures.
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