Treatment of a Chylous Fistula in the Neck with Thoracic Duct Embolization
Bibliographic record
Abstract
Introduction: Chylous fistula after lateral neck dissection for thyroid cancer is a rare but serious complication. The thoracic duct originates at the cisterna chyli (CC) and courses through the chest to the mid lateral neck before draining into the subclavian vein. If an injury and chyle leak are recognized intraoperatively, repair and drainage are performed. Effective localization and local repair can be difficult. In these patients, drainage and conservative management are recommended with a low-fat diet or parenteral nutrition. When conservative management fails, surgical clipping of the thoracic duct is classically performed. We report an alternative to surgery by percutaneous access and interventional embolization of the thoracic duct. Materials and Methods: A 53-year-old woman with a chylous fistula after a lateral neck dissection for thyroid cancer was treated unsuccessfully with conservative management. She was referred to interventional radiology for definitive thoracic duct embolization. Under general anesthesia, both groins were exposed. Radio-opaque contrast was injected using ultrasound guidance into a visible inguinal lymph node bilaterally. Lymphangiography identified a CC target and cannulation was performed using a 22-gauge needle under fluoroscopic guidance. The distal thoracic duct was first cannulated with a microwire after which coils and N-butyl cyanacrylate glue were used for complete embolization. Results: Over the next 24 hours, output stopped and the drain was removed. At 1 month follow-up, the patient had no evidence of persistent leak. Conclusions: Thoracic duct embolization can be a viable alternative for treatment of a chylous fistula after neck surgery. It may be considered in patients with persistent leakage after failure of conservative treatment. No competing financial interests exist. Runtime of video: 4 mins 51 secs
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".