Asunto(s)
Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica , Hallazgos Incidentales , Neoplasias Hepáticas/terapia , Neoplasias Quísticas, Mucinosas y Serosas/terapia , Neoplasias Primarias Múltiples , Neoplasias Pancreáticas/terapia , Anciano , Angiografía , Antibióticos Antineoplásicos/administración & dosificación , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/virología , Doxorrubicina/administración & dosificación , Endoscopía del Sistema Digestivo , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/virología , Imagen por Resonancia Magnética , Masculino , Neoplasias Quísticas, Mucinosas y Serosas/diagnóstico por imagen , Neoplasias Quísticas, Mucinosas y Serosas/patología , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/patología , Valor Predictivo de las Pruebas , Factores de Tiempo , Resultado del TratamientoRESUMEN
UNLABELLED: The thoracic duct is the body's largest lymphatic conduit, draining upwards of 75 % of lymphatic fluid and extending from the cisterna chyli to the left jugulovenous angle. While a typical course has been described, it is estimated that it is present in only 40-60% of patients, often complicating already challenging interventional procedures. The lengthy course predisposes the thoracic duct to injury from a variety of iatrogenic disruptions, as well as spontaneous benign and malignant lymphatic obstructions and idiopathic causes. Disruption of the thoracic duct frequently results in chylothoraces, which subsequently cause an immunocompromised state, contribute to nutritional depletion, and impair respiratory function. Although conservative dietary treatments exist, the majority of thoracic duct disruptions require embolization in the interventional suite. This article provides a comprehensive review of the clinical importance of the thoracic duct, relevant anatomic variants, imaging, and embolization techniques for both diagnostic and interventional radiologists as well as for the general medical practitioner. KEY POINTS: ⢠Describe clinical importance, embryologic origin, and typical course of the thoracic duct. ⢠Depict common/lesser-known thoracic duct anatomic variants and discuss their clinical significance. ⢠Outline the common causes of thoracic duct injury and indications for embolization. ⢠Review the thoracic duct embolization procedure including both pedal and intranodal approaches. ⢠Present and illustrate the success rates and complications associated with the procedure.
Asunto(s)
Embolización Terapéutica/métodos , Enfermedades Linfáticas/terapia , Linfografía/métodos , Conducto Torácico , Variación Anatómica , Drenaje , Humanos , Conducto Torácico/anatomía & histología , Conducto Torácico/diagnóstico por imagen , Conducto Torácico/embriología , Traumatismos Torácicos/complicacionesAsunto(s)
Cesárea , Cicatriz/complicaciones , Embarazo Ectópico/etiología , Adulto , Femenino , Humanos , EmbarazoAsunto(s)
Cálculos Biliares/complicaciones , Cálculos Biliares/diagnóstico por imagen , Obstrucción de la Salida Gástrica/diagnóstico por imagen , Obstrucción de la Salida Gástrica/etiología , Anciano de 80 o más Años , Endoscopía Gastrointestinal , Femenino , Cálculos Biliares/terapia , Obstrucción de la Salida Gástrica/terapia , Humanos , Litotricia , Radiografía , SíndromeRESUMEN
Cholecystocolonic fistula is an uncommon potential complication of cholecystitis found intraoperatively in 0.06-0.14 % of patients undergoing cholecystectomy and 0.1-0.5 % of autopsy series. Although cholecystocolonic fistula is the second most common cholecystoenteric fistula, second only to cholecystoduodenal fistula, it is diagnosed preoperatively in only 7.9 % of patients. Failure to preoperatively diagnose cholecystocolonic fistula places surgeons in precarious positions, as they may be forced to convert a seemingly routine cholecystectomy to a more sophisticated procedure coupled with adhesiolysis, colonic suturing, or colonic resection. We report a young patient who presented to the emergency department with complaints indicative of acute cholecystitis; however, preoperative ultrasound was suggestive of a cholecystoenteric fistula. Computed tomography and pathology were pathognomonic with clear visualization of the cholecystocolonic fistulous tract.