Lymphoscintigraphy with single-photon emission computed tomography/computed tomography is useful for determining the site of chyle leakage after esophagectomy
A 59-year-old woman was diagnosed with esophageal carcinoma of the lower intrathoracic esophagus and radical esophagectomy was performed. After surgery, more than 1 L of chylous fluid was drained via a chest tube daily for more than a week. It was expected that the patient's nutritional condition would become worse if chyle, which contains lipids, proteins, electrolytes, lymphocytes, and various other elements, leaks continuously for a long period. Therefore, we performed lymphoscintigraphy with Tc-99m-human serum albumin-diethylenetriaminepentaacetic acid (HSA-D) to identify chyle leakage site. The imaging protocol for the lymphoscintigraphy was following that after 185 MBq of Tc-99m-HSA-D was subcutaneously injected between the first and second toes of each foot, we began temporal imaging from 0 to 60 min and SPECT/CT at the time when an abnormal accumulation of the radioisotope (RI) appeared. In this case, by 10 min after the injections, lymphatic fluid in each foot flows through the lymphatic vessel of the lower limb to the lumbar lymphatic trunk. At 10 min after the injections, planar imaging revealed cisterna chyli joined by right and left lumbar lymphatic trunks and the thoracic duct above. An abnormal accumulation of the RI was observed on the left side of the thoracic duct at 10 min and it appeared to be distributed over the left thoracic cavity as time passed, which suggested chyle leakage into the left thoracic cavity []. SPECT/CT was performed to identify the accurate site of chyle leakage into the left thoracic cavity at 30 min after the injections. SPECT/CT revealed a hot spot directly on the site at which the thoracic duct was ligated during surgery, which was the suggested site of chyle leakage []. Although we considered surgical treatment for chyle leakage, it gradually decreased following conservative treatment with octreotide, a somatostatin analog,[] and did not increase again after restarting meals.