The Treatment of Neck Lymphorrhea after Total Thyroidectomy: Direct Intranodal Embolization Using N-Butyl Cyanoacrylate: A Case Report

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.

Publication History

Article published online:
26 April 2021