Thoracic Duct Stent-Graft Decompression in Advanced Colon Cancer Patient with Refractory Chylothorax Caused by Thoracic Duct Obstruction and Associated Hypertension

A 75-year-old man with a history of rectal cancer presented with a chylothorax during chemotherapy. Intranodal lymphangiography showed no leakage, but the thoracic duct was occluded distally, and there was no inflow of contrast medium into his venous angle. We percutaneously punctured the thoracic duct and inserted a microcatheter. The intra-thoracic duct pressure was over 100 mmHg, and so we reconstructed the thoracic duct with a stent-graft. The pleural effusion decreased immediately after the procedure.

Malignancy-associated chylothorax is a rare condition characterized by the accumulation of chyle within the pleural space leading to respiratory distress, malnutrition, and immunological compromise; it also prevents the continuation of chemotherapy. We report a case of malignancy-associated chylothorax caused by obstruction of the thoracic duct treated with a stent-graft.