High-Output Chylothorax: Novel Imaging Techniques Provide Specific Treatment

Post-esophagectomy chylothorax is a therapeutic dilemma. Understanding anatomy and leakage site is essential, although imaging techniques for thoracic lymphatics are challenging and not always available. We describe a patient with chylothorax post-esophagectomy from a left-sided thoracic duct traversing to the right chest. We applied intranodal Lipiodol® lymphangiography, computed tomographic lymphangiography, and performed fluorescence-guided thoracic duct ligation at the level of the aortic arch. These techniques are not only useful in a postoperative setting but may be used as preventive strategies to reduce morbidity and mortality from chylothorax after any thoracic surgical procedure where the thoracic duct is at risk.