DSA (angiography)
Frontal
Frontal
Frontal
Frontal
Frontal
Procedure performed under general anaesthesia. Ultrasound and fluoroscopic guidance. Right inguinal node accessed with 25 G spinal needle. Lipiodol injected at 1 ml q3-5mins for a total of 5-6 ml. Satisfactory opacification of cisterna chylae. Left neck chyle leak shown.
Cisterna chylae accessed via an anterior abdominal approach using fluoroscopic guidance and a 22g X 20 needle. V18 micro wire navigated up to thoracic inlet. Rebar 18 micro catheter placed. Satisfactory catheter position. The thoracic duct was occluded in the mid thoracic region with IDC detectable coils followed by by 30% strength glue (Histoacryl). Satisfactory occlusion.
Images
- Image 1: Cannulated inguinal lymph node (bottom left). Opacified efferent lyphatic duct leading on to the more dense lateral pelvic nodes
- Image 2: Abdominal lymphatics converging on the cisterna chylii, with contrast flowing up into the thoracic duct
- Image 3: Successful cannulation and advancement of a wire into the thoracic duct
- Image 4: Lymphatic leak shown (top right) and placement of 4 coils
- Image 5: post glue appearance