Techniques in vascular and interventional radiology
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Tech Vasc Interv Radiol · Dec 2016
ReviewNontraumatic Chylothorax: Diagnostic Algorithm and Treatment Options.
Nontraumatic chylothorax is a relatively rare condition in which the intestinal lymph (chyle) leaks into the pleural cavity. Nontraumatic chylothorax is more difficult to treat than the more common traumatic chylothorax because the site of chylous leak may occur in less predictable locations. ⋯ The development of this systematic approach allows better delineation of the source of the chylous leak and selection of the appropriate method of embolization. In this article, we will review the etiologies of nontraumatic chylothorax, the diagnostic work-up for managing this condition, and the treatment algorithm to care for these patients.
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The lymphatic system plays an important role in immune regulation, transport of metabolites, and fluid balance. The key circulatory role of the lymphatic system is to transport fluid from tissue back into the venous system via lymphovenous connections. Despite the centuries-old recognition of this key role, there has been poor understanding of lymphatic flow pathophysiology because of a lack of a simple reliable noninvasive clinical lymphatic imaging method. ⋯ Dynamic contrast MR lymphangiography has provided insight into understanding the pathophysiology of several pulmonary lymphatic flow disorders and provides guidance for interventional procedures. Another important development has been intranodal lymphangiogram, which has now replaced pedal lymphangiogram as the main lymphatic interventional modality, and which provides quick and reliable access to the central lymphatic ducts for interventional procedures. These new techniques have led to a resurgence in interest in the lymphatic system and the development of new treatments for patients with lymphatic flow disorders.
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Tech Vasc Interv Radiol · Dec 2016
ReviewInterventional Treatment of Pulmonary Lymphatic Anomalies.
Pulmonary lymphatic diseases have been recognized for many years and have been referred as pulmonary lymphangiectasia, pulmonary lymphangiomatosis, plastic bronchitis, and idiopathic chylothorax or chylopericardium. The lymphatic etiology of these conditions has been determined by detection of cystic lymphatic structures on biopsy or postmortem examination. Development of new imaging techniques such as dynamic contrast-enhanced magnetic resonance lymphangiography has allowed better understanding of pathophysiology of these conditions. ⋯ PLPS has been observed in all age groups and can be considered as a congenital anatomical lymphatic variant. The onset of the clinical symptoms can be provoked by increase of the lymphatic flow owing to elevated central venous pressure that results in lymphatic distention, trauma, and severe upper respiratory infection. Reported treatment of PLPS is obliteration of these abnormal lymphatic pathways by percutaneous embolization, a technique similar to thoracic duct embolization in chylothorax.
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Urinary drainage procedures are used to treat a wide range of clinical situations including pyonephrosis, preservation of renal function in patients with ureteral obstruction, as a means to access the collecting system for stone retrieval or lithotripsy and to divert urine from a distal leak or fistula. Several different drainage devices are available and include those that provide obligatory external drainage (nephrostomy), both internal and external drainage (nephroureteral stent) and internal drainage (double-J stent). ⋯ Ideally, the desired outcome can be attained with minimal effect on patient lifestyle. In this article, we present our approach to patients who require urinary drainage, with a focus on choosing and placing the most appropriate device in a variety of clinical scenarios.