Background: A 57-year-old female patient was referred for treatment of lymphatic leak after total
thyroidectomy. The patient had undergone total thyroidectomy and left level IV lymph
nodal dissection 1 week previously after which she developed swelling in the left
neck. After failed surgical attempts, the patient was referred for lymphangiography.
Results: A lymph node in the right groin was punctured using a fine needle under ultrasound
guidance and lymphangiography was performed by injecting lipiodol into the lymph node
under fluoroscopy. However, lymphangiography could not reveal the cysterna chyli and
thoracic duct, which has the role of bridge to further procedure, such as thoracic
duct embolization. On the decision to approach retrogradely, we tried to cannulate
the thoracic duct via right common femoral vein but also failed. Hence, we decide
to puncture the neck lymph node directly, and we could figure the leakage point out.
We punctured using a 22-gauge needle and then flushed with dextrose-5-water, after
which N-butyl cyanoacrylate diluted in lipiodol was injected. Two days later, a dry
tap was confirmed from the surgical drain which was successfully removed. Conclusion: While thoracic duct embolization has been reported to be successful in treating lymphatic
leaks occurring in the neck regions, reports on direct neck node embolization are
scarce. With growing interest in embolization techniques for lymphatic leaks occurring
after the surgery, this case demonstrates the application of embolization for the
treatment of lymphatic leaks in the neck. Take Home Points: The technique of direct neck node puncture and embolization is useful to treat lymphatic
leaks occurring in locations not only abdomen or thorax but also neck region.
