case_images: PMC8571355_01
case_images: (a and b) A 68-year-old male with abdominal pain and distension after radical nephrectomy diagnosed with chylous ascites. Two Axial CT images revealing large volume abdominal chylous ascites.
case_images: JCIS-11-56-g001.jpg
case_images: PMC8571355_01_JCIS-11-56-g001.jpg
case_images: F1
case_images: CT scan showed large volume abdominopelvic ascites believed to be chylous in origin [Figure 1].
case_images: Ultrasound image of the right groin showing a normal lymph node (white arrowheads) being accessed using a 21-gauge needle (white arrow) for the purposes of the lymphangiogram.
case_images: JCIS-11-56-g002.jpg
case_images: PMC8571355_01_JCIS-11-56-g002.jpg
case_images: F2
case_images: Bilateral inguinal lymph nodes were identified and accessed with 21-gauge needles using ultrasound guidance [Figure 2] (Philips, EPIQ 7, Netherlands).
case_images: (a) Single spot image of the pelvis following Lipiodol injection into the groin lymph node showing pelvic lymphatics (black arrows). (b) Spot image of the abdomen showing a linear radio-opacity in the left upper quadrant corresponding to the area of lymph node dissection with chylous leak (white arrow).
case_images: JCIS-11-56-g003.jpg
case_images: PMC8571355_01_JCIS-11-56-g003.jpg
case_images: F3
case_images: Opacification of the lymphatic channels in the retroperitoneum [Figure 3a] was confirmed with serial spot radiographic images. Active extravasation from a small lymphatic channel overlying the left psoas muscle was identified after approximately 1 h of the injection [Figure 3b].
case_images: Coronal reconstruction Cone-beam CT obtained during the lymphangiogram confirming the leak (white arrow) in the left paravertebral region.
case_images: JCIS-11-56-g004.jpg
case_images: PMC8571355_01_JCIS-11-56-g004.jpg
case_images: F4
case_images: This was confirmed by cone-beam CT [Figure 4] (Siemens Artis Zee, Erlangen, Germany).
case_images: CT guidance for glue injection (white arrow) into the focal area of chyle leak identified by the lymphangiogram.
case_images: JCIS-11-56-g005.jpg
case_images: PMC8571355_01_JCIS-11-56-g005.jpg
case_images: F5
case_images: Once CT confirmed appropriate needle location, 4 cc of 1:1 mixture of n-butyl cyanoacrylate (Cordis Neurovascular, Inc., Miami Lakes, FL) and Lipiodol was injected into the focal leak [Figure 5].
case_images: Axial contrast-enhanced CT of the abdomen following glue embolization shows retention of glue (white arrow) in the area of the focal chyle leak. Note the complete resolution of ascites.
case_images: JCIS-11-56-g006.jpg
case_images: PMC8571355_01_JCIS-11-56-g006.jpg
case_images: F6
case_images: Follow-up CT 1 month later showed complete resolution of ascites and persistent glue cast in the localized leak in the retroperitoneum [Figure 6].