technetium-tc-99m-sulfur-colloid and Chylothorax

Gorham-Stout disease (GSD) is a rare disorder characterized by multiple osteolytic lesions, sometimes complicated by chylothorax. The aim of this case report is to introduce a very rare case of Gorham-Stout syndrome, which involved several bones along with chylous pericardial and pleural effusions detected by Tc-sulfur colloid (SC) lymphoscintigraphy and single photon emission computed tomography/computed tomography (SPECT/CT).. A 15-year-old girl presented to our hospital complaining of shortness of breath and bone pain.. The CT showed multiple osteolytic lesions, left-sided pleural effusion, and pericardial effusion. Tc-SC lymphoscintigraphy showed discontinuation of thoracic duct and tracer accumulation on the left side chest. SPECT/CT revealed increased radioactivity uptake in pleural, pericardial effusions, and some thoracolumbar spines. Diagnostic thoracentesis to identify the nature of pleural effusion and histopathology of biopsy in the right femoral to that of the bone lesion were performed. Based on the clinical information, histopathologic, and radiographic findings, the diagnosis of GSD was made.. The patient received thoracic duct ligation and bisphosphonates treatment.. After receiving thoracic duct ligation and bisphosphonates treatment, the patient's symptoms of bone pain and dyspnea were relieved, and the pericardial and pleural fluid was diminished dramatically. At the 3-month and 9-month follow-up visit, the patient had nearly complete remission without any complication.. The Tc-SC lymphoscintigraphy and SPECT/CT could provide significant value assessing the lymphatic abnormity and evaluating the extent of disease, therefore aiding to guide decision making in the clinic.

Topics: Adolescent; Chylothorax; Female; Humans; Lymphoscintigraphy; Musculoskeletal Pain; Osteolysis, Essential; Radiopharmaceuticals; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Sulfur Colloid

A 7-month-old girl with history of persistent left chylous pleural effusion was referred for lymphoscintigraphy. A previous chest computed tomography (CT) scan demonstrated a small to moderate-sized left pleural effusion but could not identify the lymphatic leakage site. Lymphoscintigraphy using filtered (99m)Tc sulfur colloid showed minimal focal activity in the lower chest. A correlative single-photon emission computed tomography (SPECT)/CT localized this activity to distal paraesophageal region, being highly suggestive of the site of lymphatic leakage. Subsequent lymphangiography confirmed these findings, revealing an abnormal lymphatic branch at the level of T10 and T11 vertebrae with retrocrural extravasation toward the left hemithorax. Thoracic duct embolization was accomplished at and proximal to the site of chyle leak using a platinum coil and n-Butyl cyanoacrylate glue. The patient was followed up for >24 months and demonstrated no recurrence of pleural effusion. No ascites or other complications related to the procedure were noted. The case demonstrates that (99m)Tc sulfur colloid lymphoscintigraphy SPECT/CT can be a useful modality for detecting the chyle leakage site in children with chylothorax even when the amount of leakage is minimal.

Topics: Chyle; Chylothorax; Female; Humans; Infant; Lymphoscintigraphy; Pleural Effusion; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Topics: Chylothorax; Humans; Lymphoscintigraphy; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

A 66-y-old man was diagnosed with esophageal carcinoma and underwent a right thoracotomy and esophagectomy. Postoperatively, a recurring right pleural effusion developed. Because an attempt at lymphangiography failed, lymphoscintigraphy was suggested. Because of the inability to obtain radiolabeled albumin, dextran, or nanocolloid, we used filtered sulfur colloid. (0.1 um). The study confirmed the diagnosis of chylothorax.

Topics: Aged; Chylothorax; Humans; Lymphoscintigraphy; Male; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

Chylous effusion is an infrequent complication of cardiothoracic surgery and a less frequent complication of central line placement. The authors describe a novel application of lymphoscintigraphy showing thoracic duct injury in an infant after surgery for hypoplastic left heart syndrome.

Topics: Chylothorax; Female; Humans; Hypoplastic Left Heart Syndrome; Infant, Newborn; Postoperative Complications; Radionuclide Imaging; Reoperation; Technetium Tc 99m Sulfur Colloid; Thoracic Duct

Topics: Chylothorax; Female; Humans; Ligation; Male; Postoperative Care; Preoperative Care; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid; Thoracic Duct

To ascertain the frequency and to describe the clinical and biochemical features of cirrhotic chylothorax.. A descriptive clinical study.. A community teaching hospital.. Since November 1989 to October 1995, 809 patients with pleural effusions were studied by thoracentesis. Pleural effusions with a concentration of triglycerides higher than 110 mg/dL, a pleural fluid to serum triglyceride ratio higher than 1, and a pleural fluid to serum cholesterol ratio lower than 1 were considered chylothorax.. Twenty-four patients had pleural effusions that complied with all three aforementioned biochemical conditions. Five of these 24 patients (20%), were found to have liver cirrhosis as the main cause of chylothorax and in 3 of them, an abdominal source of the effusion could be demonstrated by intraperitoneal injection of a radioisotope (99mTc-sulfur colloid). The cirrhotic chylous effusions had significantly lower (p<0.005) protein (median, 1.7; range, 1.4 to 2.7 g/dL), lactate dehydrogenase (LDH) (median, 96; range, 77 to 138 IU/L), and cholesterol (median, 25; range, 22 to 64 mg/dL) levels than chylous effusions resulting from other causes (protein: median, 4.1; range, 1.7 to 6.8 g/dL; LDH: median, 351; range, 140 to 8,600 IU/L; and cholesterol: median, 87; range, 38 to 160 mg/dL). Cirrhotic chylothorax was always a transudate according to Light's criteria.. Chylothorax is a rare and apparently underappreciated manifestation of cirrhosis resulting from transdiaphragmatic passage of chylous ascites. Its uniform biochemical characteristics can facilitate its separation from chylous effusions of different etiology, therefore avoiding potentially harmful diagnostic and therapeutic procedures.

Topics: Adult; Aged; Aged, 80 and over; Ascites; Cholesterol; Chylothorax; Female; Follow-Up Studies; Humans; Incidence; Injections, Intraperitoneal; L-Lactate Dehydrogenase; Liver Cirrhosis; Male; Middle Aged; Paracentesis; Pleural Effusion; Proteins; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid; Triglycerides

Thirty patients diagnosed as chylothorax and chyloperitoneum (13 of chylothorax, 9 of chyloperitoneum and 8 of both) in PUMC Hospital from 1923 to 1989 were reported. Thus, the incidence rate of these two diseases is rather low. The commonest causes were iatrogenic trauma (9 cases) and malignant tumor (7 cases). Other causes were tuberculosis (5 cases), lymphangioma (2 cases), Behcet's syndrome (1 case) and non-iatrogenic trauma (1 case). The etiology was not known in 5 cases. Acute episode was observed in patients with traumatic chylous effusion; it was usually manifested as dyspnea or abdominal distention. Patients with nontraumatic chylous effusion usually run a chronic course. The characteristics of chylous effusion were analyzed. Lymphangiography and lymphoscintigraphy with 99m TC-labeled dextran play important roles in diagnosis and treatment. It has been suggested that the changes in T-cell immunocompetence is important in determining whether the treatment should be conservative or operative. If chylous effusion is due to tuberculosis, antituberculosis treatment should be instituted.

Topics: Adolescent; Adult; Aged; Chylothorax; Chylous Ascites; Female; Humans; Lymphography; Lymphoscintigraphy; Male; Middle Aged; Technetium Tc 99m Sulfur Colloid

Imaging of the thoracic duct is usually performed by radiological lymphography. However, this procedure, which uses an oil based dye injected directly into the lymph channels, has some adverse effects. In this paper we note that lymphoscintigraphy, a physiological and non invasive method, may visualize thoracic duct abnormalities, and might be particularly useful when radiological lymphography is contraindicated.

Topics: Chylothorax; Chylous Ascites; Humans; Hypertension, Portal; Lymphedema; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Thoracic Duct

Topics: Adolescent; Child; Child, Preschool; Chylothorax; Hodgkin Disease; Humans; Lymph Node Excision; Lymphedema; Lymphoscintigraphy; Neuroblastoma; Pelvic Neoplasms; Postoperative Complications; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid