Preoperative and postoperative lymphoscintigraphy using Tc-99m sulfur colloid in the repair of a lymphatic leak in a patient with traumatic chylothorax

Lymphoscintigraphy can identify abnormal lymphatic leakage and drainage in chyluria, chyloperitoneum, and chylothorax. It is a physiologic, fast, and noninvasive method and has no known adverse effects. A 19-year-old man had a massive left pleural effusion after trauma, and draining fluid was found to be chylous. Preoperative and postoperative lymphoscintigraphy were performed after subcutaneous injection of Tc-99m sulfur colloid into the first-second and fourth-fifth interdigital spaces of both feet and using a large-field-of-view gamma camera fitted with a low-energy, general purpose collimator. Preoperative lymphoscintigraphy showed abnormal focal tracer accumulation in the left subclavicular region close to the mediastinum and diffusely increased tracer uptake in the left lung field approximately 1 hour after injection. The thoracic duct was surgically ligated, and follow-up postoperative lymphoscintigraphy showed no abnormal tracer accumulation at the previously abnormal sites.