Endolymphatic exclusion for the treatment of pediatric chylous ascites secondary to neuroblastoma resection: report of two cases

Andrew Woerner; David S Shin; Jeffrey Forris Beecham Chick; Caitlin A Smith; Jay F Sarthy; Eric J Monroe

doi:10.1016/j.radcr.2020.04.060

Endolymphatic exclusion for the treatment of pediatric chylous ascites secondary to neuroblastoma resection: report of two cases

Radiol Case Rep. 2020 May 19;15(7):1044-1049. doi: 10.1016/j.radcr.2020.04.060. eCollection 2020 Jul.

Authors

Andrew Woerner¹, David S Shin¹, Jeffrey Forris Beecham Chick^{1

2}, Caitlin A Smith³, Jay F Sarthy^{4

5}, Eric J Monroe^{1

2}

Affiliations

¹ Interventional Radiology Section, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195, USA.
² Division of Vascular and Interventional Radiology, Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA.
³ Department of General Surgery, University of Washington and Seattle Children's Hospital, Seattle, WA, USA.
⁴ Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
⁵ Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA, USA.

Abstract

Chylous ascites is a rare, but highly morbid complication of oncologic resection, often associated with retroperitoneal lymphadenectomy. Conservative measures with total parenteral nutrition or lipid-reduced formulas constitute the initial mainstay therapy, but not without risks and failures. This report describes 2 endolymphatic treatment strategies for iatrogenic chylous ascites following neuroblastoma resection. Lymphatic leaks were identified using intranodal lymphangiography, targeted with cone-beam computed tomographic guidance, and embolized with n-butyl cyanoacrylate. There were no adverse outcomes, with complete resolution of chylous ascites and a mean follow-up of 26 months.

Keywords: CBCT, Cone Beam Computed Tomography; Chylous ascites; Cone beam computed tomography; Interventional radiology; Lymphatic; Oncology; Pediatrics; n-BCA, n-butyl Cyanoacrylate.

Publication types

Case Reports