Tadataka Hirai, Hiroyasu Fujiwara, Tomoki Yamatsuji, Susumu Kanazawa, Katsuya Kato
We report the case of an 85-year-old woman with high-output chylothorax that developed after esophagectomy with thoracic duct ligation. Lymphangiography identified a leak site on the dorsal side of the left main bronchus, but failed to control the leak. Targeted sclerotherapy at the leak point temporarily reduced drainage but did not achieve closure. A mediastinal lymph node in the left retrocrural space that retained lipiodol from the previous lymphangiography was punctured under computed tomography guidance, followed by the injection of N-butyl cyanoacrylate glue, which occluded the leaking lymphatic channel. The drainage rapidly stopped, and the patient had no recurrence. Computed tomography-guided mediastinal lymph node puncture may be a minimally invasive alternative when conventional thoracic duct embolization is not feasible.