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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
7. Nadolski G. Nontraumatic Chylothorax: Diagnostic Algorithm and Treatment Options. Tech Vasc Interv Radiol. 2016 Dec;19(4):S1089-2516(16)30047-6. Review/Other-Dx N/A To review the etiologies of nontraumatic chylothorax, the diagnostic work-up for managing this condition, and the treatment algorithm to care for these patients. No results stated in abstract. 4
8. Takuwa T, Yoshida J, Ono S, et al. Low-fat diet management strategy for chylothorax after pulmonary resection and lymph node dissection for primary lung cancer. Journal of Thoracic & Cardiovascular Surgery. 146(3):571-4, 2013 Sep.J Thorac Cardiovasc Surg. 146(3):571-4, 2013 Sep. Review/Other-Dx 1580 We reviewed our experience of iatrogenic chylothorax after pulmonary resection for primary lung cancer to evaluate a low-fat diet management strategy. Postoperative chylothorax developed in 37 patients (2.3%), 33 men and 4 women, with a median age of 69 years (range, 44-84). The initial procedures were pneumonectomy in 1 patient and lobectomy in 36 patients. In 23 patients (62%), their condition resolved with the low-fat diet only. A total of 10 patients underwent OK-432 pleurodesis, and 8 of these were cured with continuation of the low-fat diet. These 31 patients who responded to conservative treatment (84%) resumed a normal diet at a median of 10 days (range, 5-27) after the chylothorax diagnosis. The remaining 6 patients (16%) underwent reoperation and were discharged at a median of 18 days (range, 14-33) after the initial surgery. 4
9. Ji H, Wang Z, Xu C, Yu X, Huang H. Prognostic significance of Pleural Fluid triglyceride levels based on a low-Fat Diet Management Strategy in patients with Chylothorax following pulmonary resection. Journal Of Cardiothoracic Surgery. 19(1):337, 2024 Jun 20.J Cardiothorac Surg. 19(1):337, 2024 Jun 20. Observational-Dx 2942 Chylothorax is a postoperative complication in patients with lung cancer. Diet-control approaches have been the mainstay for managing this condition. However, a surgical intervention is needed for the patients if conservative treatment is ineffective. Because of the lack of accurate indicators to assess the prognosis of the postoperative complication at an early stage, the criteria of surgical treatment were not consistent. Postoperative chylothorax occurred in 108 patients and 79 patients were treated with a low-fat diet management while 29 patients were managed with TPN. In contrast to drainage volume, the pleural effusion triglyceride level after 2 days of low-fat diet exhibited enhanced predictive efficacy in predicting patient prognosis. When the pleural fluid triglyceride level of 1.33 mmol/L was used as the diagnostic threshold for prognosis, the sensitivity and specificity reached 100% and 80.6%, respectively 4
10. Agrawal A, Chaddha U, Kaul V, Desai A, Gillaspie E, Maldonado F. Multidisciplinary Management of Chylothorax. [Review]. Chest. 162(6):1402-1412, 2022 Dec.Chest. 162(6):1402-1412, 2022 Dec. Review/Other-Tx N/A To review the current literature and propose a stepwise, evidence-based multidisciplinary approach to the management of patients with both traumatic and nontraumatic chylothorax. No results in abstract. 4
11. Ismail NA, Gordon J, Dunning J. The use of octreotide in the treatment of chylothorax following cardiothoracic surgery. [Review]. Interactive Cardiovascular & Thoracic Surgery. 20(6):848-54, 2015 Jun.Interact Cardiovasc Thorac Surg. 20(6):848-54, 2015 Jun. Review/Other-Tx N/A To examine the effectiveness of treating chylothorax by comparing octreotide in patients with a chylothorax after thoracic surgery and patients with limited dietary fat intake alone. Altogether 180 papers were found using the reported search, of which 20 represented the best evidence to answer the clinical question. One case was reported twice and therefore was excluded, leaving us with 19 papers. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Although rare, iatrogenic and traumatic chylothorax have been well described in the literature. At present, there have been no randomized controlled clinical trials on the use of octreotide in chylothorax. Sixteen of 19 papers found octreotide to be effective in the treatment of chylothorax. Octreotide was found to have no complementary effect in three reports. Two of the papers were retrospective studies: one a randomized controlled trial in canines, and the remainder were case reports and case series. The two retrospective studies showed a success rate of 87-90% in the use of octreotide as an adjunct to conservative management for the treatment of chylothorax and hence preventing the need for further surgery. Experimental study in canines has shown significant drain reduction and earlier fistula closure, although transferability of this result to human is difficult to interpret. Twelve case reports found octreotide effective in reduction of the volume and arrest of chylothorax. Most reported benefit in 2-3 days of administration of octreotide. The general consensus is for conservative management with octreotide to be instituted for 1 week before consideration of surgery, although some authors have advocated for a large volume chylothorax, especially after oesophageal surgery with no response to conservative management with octreotide, to be operated on sooner. 4
12. Chan JY, Wong EW, Ng SK, van Hasselt CA, Vlantis AC. Conservative management of postoperative chylous fistula with octreotide and peripheral total parenteral nutrition. Ear, Nose, & Throat Journal. 96(7):264-267, 2017 Jul.Ear Nose Throat J. 96(7):264-267, 2017 Jul. Observational-Tx 10 patients with chylous fistulae after neck dissections To present our institution's experience and discuss our observations during management of this complication with the use of peripheral total parenteral nutrition (TPN) and octreotide acetate. Mean age of the patients was 63.0 years (range 49 to 82). Five (50.0%) had a neck dissection for the management of metastatic nasopharyngeal carcinoma and had previous neck irradiation. In 8 (80%) patients, chylous fistula occurred in the left neck. Seven (70.0%) of the leaks occurred within the first 2 postoperative days. Eight (80%) leaks were controlled using TPN and octreotide, with 2 (20%) patients requiring surgical intervention. No factors were significant in the successful conservative management of chylous fistulae. One patient with a chylous fistula of 1,800 ml/day was managed successfully without surgical intervention. 3
13. Jacob S, Meneses A, Landolfo K, et al. Incidence, Management, and Outcomes of Chylothorax after Lung Transplantation: A Single-center Experience. Cureus. 11(7):e5190, 2019 Jul 22.Cureus. 11(7):e5190, 2019 Jul 22. Review/Other-Tx 504 patients To determine the incidence, management, and outcomes of post-operative chylothorax in lung transplant recipients at our institution. Chylothorax presented in the first week in four (62.5%) patients, and approximately one month later in the remaining three. Nonsurgical management was initially attempted in all patients and succeeded in three (42.9%). Elective surgical ligation of the thoracic duct (LTD) was successful in two (66.7%) out of three patients in whom it was performed. One patient required emergent reoperation for clamshell thoracotomy dehiscence from severe chylothorax. Thoracic duct embolization was attempted but unsuccessful in two patients. Subsequently, one of these patients received a peritoneal-venous shunt and the other underwent LTD. Chylothorax permanently resolved in six patients (85.7%). There were no mortalities directly related to chylothorax. The median time to resolution was 11 days (range: 7-60). The mean survival in months for chylothorax patients was 29.2 (SE 3.1) and 78.2 (SE 2.9) for the remaining patients (p = 0.37). The median survival was not reached for the chylothorax group and was 71.8 months (95% CI: 58.0-83.9) for the rest. 4
14. Power R, Smyth P, Donlon NE, Nugent T, Donohoe CL, Reynolds JV. Management of chyle leaks following esophageal resection: a systematic review. Diseases of the Esophagus. 34(11), 2021 Nov 11.Dis Esophagus. 34(11), 2021 Nov 11. Review/Other-Tx 25 studies To conduct a systematic literature search with the goal of synthesizing the evidence base and informing a discussion that may result in clear guidelines for the management of chyle leaks following esophageal resection. A total of 530 citations were reviewed. Twenty-five studies, totaling 1016 patients met the inclusion criteria, including two low-quality clinical trials and 23 retrospective case series. Heterogeneity of study design and outcomes prevented meta-analysis. The overall incidence of chyle leak/fistula was 3.2%. Eighteen studies describe management of chyle leaks conservatively, 17 by surgical ligation of the thoracic duct, 5 by pleurodesis, and 6 described percutaneous lymphangiography with thoracic duct embolization or disruption. 4
15. Deboever N, Feldman H, Eisenberg M, et al. Octreotide's role in the management of post-esophagectomy chylothorax. Diseases of the Esophagus. 37(6), 2024 Jun 01.Dis Esophagus. 37(6), 2024 Jun 01. Observational-Tx 74 patients To perform a single-institution review of outcomes from octreotide use for chyle leak following esophagectomy and to specifically assess the effect of octreotide on chest tube duration (CTD), hospital length of stay (LOS), and overall survival. The study was performed using a prospective, single-center database, from which clinicopathologic characteristics were extracted of patients who had post-esophagectomy chyle leaks. Kaplan–Meier and multivariable Cox regression analyses were performed to investigate the effect of octreotide use on chest tube duration (CTD), hospital length of stay (LOS), and overall survival (OS). In our cohort, 74 patients met inclusion criteria, among whom 27 (36.5%) received octreotide. Kaplan–Meier revealed no significant effect of octreotide on CTD (P?=?0.890), LOS (P?=?0.740), or OS (P?=?0.570). Multivariable Cox regression analyses further corroborated that octreotide had no effect on CTD (HR?=?0.62, 95% confidence interval [CI]: 0.32–1.20, P?=?0.155), LOS (HR?=?0.64, CI: 0.34–1.21, P?=?0.168), or OS (1.08, CI: 0.53–2.19, P?=?0.833). 2
16. Cho HJ, Kim DK, Lee GD, et al. Chylothorax complicating pulmonary resection for lung cancer: effective management and pleurodesis. Ann Thorac Surg. 2014 Feb;97(2):S0003-4975(13)02390-4. Review/Other-Dx 67 To investigate the effectiveness of a conservative approach (diet or pleurodesis) to the management of chylothorax. Right-sided chylothorax was more common than left-sided chylothorax (p [ 0.033). All patients were initially treated with nil per os (NPO; n [ 46) or a low long-chain triglyceride (LCT) diet (n [ 21). In the NPO group, 24 patients were successfully treated with diet alone and 20 underwent pleurodesis. In the LCT group, 10 patients were successfully treated with diet alone; of the 11 remaining patients, 4 patients improved after NPO. The 7 patients who did not improve with NPO underwent pleurodesis. No significant differences in chest tube output before and after initial treatment, length of stay, or success rate were observed between patients initially treated with NPO and those receiving low LCT. All 32 pleurodeses performed in 27 patients were successful. Two patients underwent surgery without pleurodesis after dietary treatment failure. Postoperative air leakage or drainage for 5 days greater than 21.6 mL/kg were independent risk factors for dietary treatment failure. 4
17. Reisenauer JS, Puig CA, Reisenauer CJ, et al. Treatment of Postsurgical Chylothorax. Annals of Thoracic Surgery. 105(1):254-262, 2018 Jan.Ann Thorac Surg. 105(1):254-262, 2018 Jan. Review/Other-Dx 97 The objective of this study was to determine the efficacy of standard therapies, such as surgical duct ligation and observation, compared with newer treatment methods (thoracic duct embolization). Postoperative chylothorax occurred in 97 patients, including 54 men (56%). The median age was 61 years (range, 24 to 87 years). Thoracic duct leak followed esophagectomy in 46 patients (47%), pulmonary resection in 30 (31%), mediastinal mass resection in 7 (8%), and after other procedures in 15. Of 28 medically observed patients achieving resolution without intervention, the median peak chest tube output in 24 hours was 725 mL compared with 1,910 mL in the group that required intervention (p [ 0.0001). Thoracic duct ligation was successful in 44 of 52 patients that proceeded to the operating room (85%). Of the 40 patients undergoing diagnostic lymphangiography, a leak was identified in 34 (85%), but the cisterna chyli could only be cannulated in 19 (48%) and was subsequently successful in 15 (38%). 4
18. Kim PH, Tsauo J, Shin JH. Lymphatic Interventions for Chylothorax: A Systematic Review and Meta-Analysis. [Review]. Journal of Vascular & Interventional Radiology. 29(2):194-202.e4, 2018 02.J Vasc Interv Radiol. 29(2):194-202.e4, 2018 02. Review/Other-Dx 407 To perform a systematic review and meta-analysis of published studies to evaluate the efficacy of lymphatic interventions for chylothorax. The cases of 407 patients from 9 studies were evaluated. The pooled technical success rates of LAG and TDE were 94.2% (95% confidence interval [CI], 88.4%–97.2%; I2 ¼ 46.7%) and 63.1% (95% CI, 55.4%–70.2%; I2 ¼ 37.3%), respectively. The pooled clinical success rates of LAG, TDE, and TDD, on a per-protocol basis, were 56.6% (95% CI, 45.4%–67.2%; I2 ¼ 5.4%), 79.4% (95% CI, 64.8%–89.0%; I2 ¼ 68.1%), and 60.8% (95% CI, 49.4%–71.2%; I2 ¼ 0%), respectively. The pooled major complication rate of LAG and TDE was 1.9% (95% CI, 0.8%–4.3%; I2 ¼ 0%) and 2.4% (95% CI, 0.9%–6.6%; I2 ¼ 26.4%), respectively. The pooled overall clinical success rate of lymphatic interventions, on an intention-to-treat basis, was 60.1% (95% CI, 52.1%–67.7%; I2 ¼ 54.3%). Etiology of chylothorax was identified as a significant source of heterogeneity for the pooled clinical success rate of TDE and overall clinical success rate. 4
19. Zheng J, Chen YY, Zhang CY, Zhang WQ, Rao ZY. The retrospective research of enteral nutrition with medium-chain triglyceride and total parenteral nutrition support of postoperative chylothorax in adults. SAGE Open Medicine. 8:2050312120938221, 2020.SAGE Open Med. 8:2050312120938221, 2020. Observational-Tx 35 Our study aimed to research the optimum nutrition support method for chylothorax. The results were similar in patients with all surgeries and patients with only post heart surgery. The total cost during hospitalization in E group was higher than T group (P<0.01), whereas the nutrition support cost was lower (P<0.001). The length of hospital stay was longer in E group than T group (P>0.05). Time from admission to surgery was shorter and from surgery to chylothorax diagnosis was longer in E group compared with T group. Time to resolution and removal of drainage was shorter in E group than T group but the differences were not significant. 3
20. Gilyard SN, Khaja MS, Goswami AK, Kokabi N, Saad WE, Majdalany BS. Traumatic Chylothorax: Approach and Outcomes. [Review]. Seminars in Interventional Radiology. 37(3):263-268, 2020 Aug.SEMIN. INTERVENT. RADIOL.. 37(3):263-268, 2020 Aug. Review/Other-Tx N/A An overview of the clinical and technical approach to thoracic duct embolization for traumatic chylothorax is presented in addition to a review of outcomes. In both adults and children, lymphangiography and TDE for the management of traumatic chylothorax has emerged as the treatment modality of choice in the frequent instance of conservative management failure 4
21. Zhang K, Li C, Zhang M, Li Y. Treatment of Chylothorax complicating pulmonary resection with hypertonic glucose Pleurodesis. Journal Of Cardiothoracic Surgery. 16(1):149, 2021 May 28.J Cardiothorac Surg. 16(1):149, 2021 May 28. Observational-Tx 58 To retrospectively assess the efficacy of hypertonic glucose pleurodesis for treatment of chylothorax after pulmonary resection. Conservative treatment was successful in 50 (86.2%) patients, while eight patients [mean age: 58.0 years (range, 45-75)] were treated with hypertonic glucose pleurodesis. All eight patients had undergone operation for lung cancer (four squamous cell carcinomas and four adenocarcinomas). The bronchial stump was covered by pleural flap in three patients. After pleurodesis, three patients developed fever but without empyema; thoracentesis was performed in two patients. The mean time interval between pleurodesis and operation was 4.3 days (range,3-5) days. The average length of stay was 23.1 days (range, 18-31). No recurrent pleural effusion was observed over a mean follow-up duration of 28 months. 4
22. Yasuura Y, Konno H, Hayakawa T, et al. Chylothorax after pulmonary resection and lymph node dissection for primary lung cancer; retrospective observational study. Journal Of Cardiothoracic Surgery. 17(1):11, 2022 Jan 22.J Cardiothorac Surg. 17(1):11, 2022 Jan 22. Observational-Dx 2019 Pulmonary resection with mediastinal lymph node dissection for treating primary lung cancer could sometimes causes chylothorax as a postoperative complication. This study examined the validity of treatments for chylothorax in our hospital. Postoperative chylothorax occurred in 37 patients (1.8%), 20 men and 17 women, with a median age of 70 years (33-80). A low-fat diet was instituted to all patients; 35 cases improved with conservative treatment, and 2 cases required reoperation. Nine cases had a drainage volume = 500 mL one day following the low-fat diet commencement, which was resolved with conservative treatment and decreased drainage was observed on the third day of treatment in seven of those cases. Two cases with excessive drainage of = 1000 mL in one day and systemic symptoms associated with chyle loss needed surgery. 4
23. Zhu X, Feng X, Huang Z, et al. Analysis of related factors and treatment effect of chylothorax after lung surgery. Journal of Thoracic Disease. 16(5):3291-3305, 2024 May 31.J. thorac. dis.. 16(5):3291-3305, 2024 May 31. Observational-Dx 5706 Chylothorax is a seldom encountered complication following lung surgery. However, due to the widespread practice of lung surgery, postoperative complications have inevitably arisen. Chylothorax significantly affects a patient's discharge and recovery. This study investigates the risk factors for postoperative chylothorax at our center and analyzes various treatment modalities and prognostic outcomes. Postoperative chylothorax occurred in 42 of 5,706 patients after lung surgery. General information and disease-related data of the chylothorax and control group were analyzed by univariate and multivariate analyses. Multivariate analysis showed that serum albumin before surgery [odds ratio (OR) =0.86, 95% confidence interval (CI): 0.81-0.91, P<0.001], ?-glutamyl transferase level before surgery (after logarithmic transformation, OR =1.01, 95% CI: 1.00-1.01, P=0.01), squamous cell carcinoma (OR =2.77, 95% CI: 1.37-5.6, P=0.008), right mediastinal lymph node dissection (OR =3.15, 95% CI: 1.62-6.14, P<0.001) were independent risk factors for postoperative chylothorax. Among the 42 cases of postoperative chylothorax, 26 patients were improved with conservative treatments, and 6 patients were improved with chemical pleurodesis. Eight patients with postoperative chylothorax underwent thoracoscopic thoracic duct ligation. Three patients experienced severe postoperative complications: one was discharged after prolonged treatment, while the remaining two either succumbed or were discharged against medical advice. 4
24. Kariya S, Nakatani M, Ueno Y, et al. Transvenous Retrograde Thoracic Ductography: Initial Experience with 13 Consecutive Cases. Cardiovascular & Interventional Radiology. 41(3):406-414, 2018 Mar.Cardiovasc Intervent Radiol. 41(3):406-414, 2018 Mar. Observational-Dx 13 To report the feasibility and findings of transvenous retrograde thoracic duct cannulation. The catheter could be inserted to the cervical part, thoracic part, and cisterna chyli in 12 (92.3%), nine (69.2%), and six (46.2%) patients, respectively. Successful transvenous thoracic ductography was performed in eight patients (61.5%). The cervical part of the thoracic duct was branched into a plexiform configuration beyond which the microcatheter could not be advanced to reach the thoracic part in three unsuccessful cases. The success rate of transvenous thoracic ductography was significantly higher with the simple type (80%) than with the plexiform type (0%; p = 0.035). No extravasation of contrast agent was seen in the eight patients with successful thoracic ductography. Thoracic duct embolization was performed in one patient with a chylous pericardial effusion in whom myriad lymph ducts connecting to the hilar and pericardial regions from the thoracic duct were found, and drainage was unnecessary. 4
25. Majdalany BS, Sanogo ML, Pabon-Ramos WM, et al. Complications during Lymphangiography and Lymphatic Interventions. Semin Intervent Radiol. 2020 Aug;37(3):309-317. Review/Other-Dx N/A To discuss potential complications of lymphangiography and those encountered while performing lymphatic interventions along with approaches to minimize their risk and management strategies should they occur. No results in abstract. 4
26. Moon S, Park J, Kim GM, et al. Thoracic Duct Embolization for Treatment of Chyle Leakage After Thyroidectomy and Neck Dissection. Korean Journal of Radiology. 25(1):55-61, 2024 Jan.Korean J Radiol. 25(1):55-61, 2024 Jan. Observational-Tx 12 This study aimed to evaluate the safety and efficacy of intranodal lymphangiography and thoracic duct embolization (TDE) for chyle leakage (CL) after thyroid surgery. On lymphangiography, ethiodized oil leakage near the surgical bed was identified in 12 of 14 patients (85.7%). The technical success rate of TDE was 78.6% (11/14). Transabdominal antegrade access was not feasible due to the inability to visualize the identifiable cisterna chyli or a prominent lumbar lymphatic duct. Among patients who underwent a technically successful TDE, the clinical success rate was 90.1% (10/11). The median time from the procedure to drain removal was 3 days (with a range of 1–13 days) for the 13 patients who underwent surgical drainage. No CL recurrence was observed during the follow-up period (ranging from 2–44 months; median, 8 months). There were no complications, except for one case of chylothorax that developed after TDE 4
27. Uchida S, Suzuki K, Hattori A, Takamochi K, Oh S. Surgical intervention strategy for postoperative chylothorax after lung resection. Surgery Today. 46(2):197-202, 2016 Feb.SURG. TODAY. 46(2):197-202, 2016 Feb. Observational-Tx 50 patients who suffered postoperative chylothorax (41 in conservative group and 9 in surgical group) To evaluate the treatment strategy for postoperative chylothorax and identify associated predictors of surgical intervention. Forty-one (82 %) patients were treated conservatively and 9 (18 %) underwent reoperation, as direct or concomitant ligation of the thoracic duct at the point of leakage. The frequency of postoperative chest tube drainage just after initial surgery was significantly greater in the surgical group than the conservative group before oral intake was restarted (448 ± 189 vs. 296 ± 117 ml/12 h, respectively; p = 0.003). Furthermore, it was a significant predictor of reoperation based on a multivariate analysis (p = 0.010). 3
28. Cuong NN, Hoan L, Tra My TT, et al. Minimally Invasive Treatment of Chyle Leak After Thyroidectomy and Cervical Lymph Node Dissection in Patients with Thyroid Carcinoma: Results of a Study Involving 36 Patients. Therapeutics & Clinical Risk Management. 20:75-82, 2024.Ther Clin Risk Manag. 20:75-82, 2024. Observational-Tx 36 patients with chyle leak after neck surgery for thyroid cancer To report on a recent innovation in lymphatic intervention for treating such patients. Antegrade catheterization of the thoracic duct was achieved in 31 of 36 patients (86.1%). Therefore, embolization of the thoracic duct and thoracic duct branches was performed in 26 and 5 patients, respectively. In 5 cases of unsuccessful antegrade catheterization into the thoracic duct, transcervical access embolization was performed in 2 patients, and TD disruption (TDD) was performed in 3 patients. The pooled overall technical success rate of lymphatic embolization was 33/36 patients (91.7%). One patient who underwent thoracic duct embolization (TDE) with technical success (1/33 patients) but clinical failure had additional treatment directly sclerosing the TD under computed tomography scan. Cervical fluid collection sclerotherapy was done in 7 patients as an additional treatment. Resolution of the chyle leak after procedures was observed in all patients (100%). The mean time to resolution was 3 days (1-7 days). There was no complication intra and after procedures. 3
29. Tsuchitani Y, Ozawa Y, Taniyama Y, et al. Risk Factors and Treatment of Chylothorax After Minimally Invasive Esophagectomy for Esophageal Cancer. Cureus. 16(7):e65606, 2024 Jul.Cureus. 16(7):e65606, 2024 Jul. Observational-Tx 727 patients with esophageal cancer who underwent minimally invasive esophagectomy To identify the risk factors for chylothorax in minimally invasive esophagectomy (MIE) and evaluate the indications for managing chylothorax, particularly with a specific focus on surgical intervention. Of the 727 patients, 18 (2.5%) developed a chylothorax. The mean BMI was lower (20.3 vs. 21.9, p=0.057), and more cases of thoracic duct resection were found in the chylothorax group (33.3% vs. 6.2%, p=0.001), with statistical significance. Multivariate analysis identified thoracic duct resection as a risk factor (adjusted odds ratio, 6.83). The drainage volume two days after chylothorax was higher in the surgery group, although the difference was not statistically significant (surgery group, 1,405 ml vs. conversion group, 260 ml vs. conservative group, 310 ml; p=0.073). The surgery group had the shortest median postoperative hospital days among these groups (21.5 as compared to 102 and 25.0 days in the conversion and conservative groups, respectively; p<0.001). None of the patients died during their hospital stays. 3
30. Papatheodorou P, Taliadoros A, Thrasyvoulou C, Tsironis G. Sclerosing angiomatoid nodular transformation of the spleen: a case report. BMJ Case Rep. 2021 Dec 23;14(12):e246993. Review/Other-Dx 1 patient Sclerosing angiomatoid nodular transformation (SANT) of the spleen is an uncommon primary benign condition with specific histopathological characteristics. We report a 55-year-old woman who was presented to the surgical team of our hospital for splenectomy after the investigation of an incidental splenic lesion led to the diagnosis of SANT. The pathology report of the specimen repeated the initial diagnosis. The patient has not yet presented any complication or recurrence of the disease 8 months after the operation. 4
31. Goity LD, Itkin M, Nadolski G. An Algorithmic Approach to Minimally Invasive Management of Nontraumatic Chylothorax. [Review]. Seminars in Interventional Radiology. 37(3):269-273, 2020 Aug.SEMIN. INTERVENT. RADIOL.. 37(3):269-273, 2020 Aug. Review/Other-Tx N/A We summarize etiologies of nontraumatic chylothorax, offer an updated treatment algorithm to stratify affected patients and determine appropriate treatment options, and review procedural techniques critical to efficient and effective treatment. Nontraumatic chylothorax is a rare condition, stemming from a wide variety of disease states, and is more difficult to treat than traumatic chylothorax. Expectations for outcomes should be tempered, as the proportion of clinical success in thetreatment of nontraumatic chylothorax is significantly lower than the success in the treatment of its traumatic counterpart. Despite this, through innovative imaging and procedural techniques, a treatment algorithm (?Fig. 3) is proposed that will likely result in improved treatment outcomes and a more auspicious era for affected patients. 4
32. Fukumoto A, Terao T, Kuzume A, et al. Management of lymphoma-associated chylothorax by interventional radiology and chemotherapy: a report of five cases. International Journal of Hematology. 116(4):579-585, 2022 Oct.Int J Hematol. 116(4):579-585, 2022 Oct. Review/Other-Tx 5 patients To describe the cases of five patients with lymphoma-associated chylothorax with the aim of clarifying an effective treatment strategy. All patients achieved a partial response or better for lymphoma. All patients underwent interventional radiology (IVR) procedures, including lymphangiography (LAG) and thoracic duct embolization (TDE). Complete resolution of chylothorax was eventually achieved by IVR procedures or pleurodesis in all patients. No patients experienced serious adverse events related to LAG/TDE. Treatment of chylous effusion required months for most patients (range: 0.2-4.8 months). Our data suggest that a combination of chemotherapy and LAG/TDE is effective for refractory lymphoma-related chylous effusion. 4
33. Lutz P, Strunk H, Schild HH, Sauerbruch T. Transjugular intrahepatic portosystemic shunt in refractory chylothorax due to liver cirrhosis. World Journal of Gastroenterology. 19(7):1140-2, 2013 Feb 21.World J Gastroenterol. 19(7):1140-2, 2013 Feb 21. Review/Other-Tx N/A To report on the case of a 59-year-old woman with severe dyspnea due to a large chylothorax. No results in abstract. 4
34. Lv Y, Han G, Fan D. Hepatic Hydrothorax. [Review]. Annals of Hepatology. 17(1):33-46, 2018 January-February.Ann Hepatol. 17(1):33-46, 2018 January-February. Review/Other-Tx N/A To review the pathophysiology, manifestations, diagnosis, and therapeutic options available for the management of HH will be discussed in order to allow the clinician to better understand these potentially lifethreatening complications. No results in abstract. 4
35. Yang Z, Li Y, Chen H, et al. Comparison of the Effectiveness of Inguinal Lymphangiography and Transjugular Intrahepatic Portosystemic Shunt Creation in Cirrhosis-Related Chylous Ascites. Journal of Vascular & Interventional Radiology. 36(8):1341-1346, 2025 08.J Vasc Interv Radiol. 36(8):1341-1346, 2025 08. Review/Other-Dx 10 patients To investigate the effectiveness of ethiodized oil lymphangiography and transjugular intrahepatic portosystemic shunt (TIPS) creation in cirrhosis-related chylous ascites. After the failure of conservative treatment, patients underwent inguinal nodal ethiodized oil lymphangiography to identify and embolize the chylous leakage first, and then, the TIPS procedure was performed. Symptoms of chylous leakage were not controlled after ethiodized oil lymphangiography, including patients' weight increase, abdominal circumference increase, and serum albumin level decrease. After undergoing TIPS procedure 1 week later, chylous ascites was gradually alleviated, manifested as weight decrease, abdominal circumference decrease, and serum albumin level maintenance. In mean follow-up of 15.6 months (SD ± 11.6), all chylous ascites was relieved without recurrence. In summary, ethiodized oil inguinal node lymphangiography was not capable of identifying and controlling lymphatic leakage; however, TIPS creation was an effective method to control chylous ascites in patients with cirrhosis. 4
36. Kim J, Won JH. Percutaneous Treatment of Chylous Ascites. [Review]. Techniques in Vascular & Interventional Radiology. 19(4):291-298, 2016 Dec.Tech Vasc Interv Radiol. 19(4):291-298, 2016 Dec. Review/Other-Tx N/A To review the options and techniques for percutaneous treatment of lymphatic leaks in patients presenting with chylous ascites. No results in abstract. 4
37. Yarmohammadi H, Schilsky J, Durack JC, et al. Treatment of Chylous Ascites with Peritoneovenous Shunt (Denver Shunt) following Retroperitoneal Lymph Node Dissection in Patients with Urological Malignancies: Update of Efficacy and Predictors of Complications. Journal of Urology. 204(4):818-823, 2020 10.J Urol. 204(4):818-823, 2020 10. Observational-Tx 20 patients with refractory chylous ascites after retroperitoneal lymph node dissection treated with peritoneovenous shunt To investigate the efficacy and analyzed the complication risk factors of peritoneovenous shunt in treating refractory chylous ascites following retroperitoneal lymph node dissection in patients with urological malignancies. Twenty patients were included in this study. Testicular cancer was the most common malignancy (85%). The mean number of days from surgery to detection of chylous ascites was 21 days (SD 15, range 4 to 65). Ascites permanently resolved after peritoneovenous shunt in 18 patients (90%), leading to shunt removal in 17 patients (85%) between 46 and 481 days (mean 162, SD 141). The mean serum albumin level increased 24% after shunt placement (mean 3.0±0.6 gm/dl before, 3.9±0.8 gm/dl after, p <0.05). The most common complication was occlusion (30%). Relative risk of complications increased significantly when shunt placement was more than 70 days after surgery and in patients with more than 5 paracenteses before peritoneovenous shunt placement (AR 0.71% vs 0.25%, RR 2.9, p <0.048 and AR 0.6% vs 0.125%, RR 4.8, p <0.04, respectively). 2
38. Aly AK, Santos E, Fung J, et al. Intranodal Lymphangiography and Embolization for Management of Iatrogenic Chylous Ascites after Oncological Surgery. Journal of Vascular & Interventional Radiology. 35(6):883-889, 2024 06.J Vasc Interv Radiol. 35(6):883-889, 2024 06. Review/Other-Tx 39 patients who underwent 55 procedures To investigate the safety and effectiveness of intranodal lymphangiography (INL) and lymphatic embolization (LE) in management of chylous ascites after oncologic surgery. INL was technically successful in 54 of 55 procedures (98%; 95% confidence interval [CI], 90%-100%). A lymphatic leak was identified in 40 procedures, and LE was attempted in 36. LE was technically successful in 33 of the 36 procedures (92%; 95% CI, 78%-98%). Clinical success, defined as resolution of ascites with no need for peritoneovenous shunt placement or additional surgery, was achieved in 22 of 39 patients (56%; 95% CI, 40%-72%). Clinical success was achieved in 18 patients after 1 procedure, and patients who required repeat procedures were less likely to achieve clinical success (odds ratio, 0.16; 95% CI, 0.04-0.66; P = .012). Four grade 1 procedural adverse events were recorded. 4
39. Griffo S, De Luca G, Stassano P. Chylothorax after abdominal surgery. General Thoracic & Cardiovascular Surgery. 58(3):159-62, 2010 Mar.Gen Thorac Cardiovasc Surg. 58(3):159-62, 2010 Mar. Review/Other-Tx 3 patients To review three cases of chylothorax after abdominal surgery. No results stated in the abstract. 4
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