{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:56:27Z","timestamp":1790747787506,"version":"4.1.0"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["CVIR Endovasc"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Lymphoma-associated chylothorax is a challenging condition in which thoracic duct embolization (TDE) has limited efficacy because lymphatic leakage is often multifocal and difficult to localize. Furthermore, TDE performed without confirmed localization of the leakage site may increase upstream intralymphatic pressure and paradoxically worsen chylous leakage. Accurate localization of the leakage site before intervention is therefore essential.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 53-year-old man with low-grade B-cell lymphoma developed refractory bilateral chylothorax during chemotherapy. Conventional intranodal lymphangiography (INL) performed on two occasions failed to identify the leakage site, yet TDE was performed at the referring institution and was followed by marked clinical deterioration. Dynamic contrast-enhanced MR lymphangiography (DCE-MRL) subsequently demonstrated active lymphatic leakage from the residual lymphoma lesion. CT-guided direct embolization with n-butyl-2-cyanoacrylate (NBCA) was performed in four sessions, followed by surgical pleurodesis for persistent right-sided chylothorax, resulting in durable resolution without recurrence during 29\u00a0months of follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights the importance of avoiding TDE without confirmed localization of the leakage site in refractory lymphoma-associated chylothorax. When conventional lymphangiography fails to identify the leakage site, DCE-MRL may facilitate targeted intervention and improve treatment planning. CT-guided direct embolization may represent a useful therapeutic option in carefully selected patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s42155-026-00780-x","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:01:52Z","timestamp":1790744512000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Successful management of refractory lymphoma-associated chylothorax with CT-guided direct embolization and pleurodesis"],"prefix":"10.1186","volume":"9","author":[{"given":"Yosuke","family":"Yamamoto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jitsuro","family":"Tsukada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Tamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Yoshikawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuji","family":"Furukawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Ogawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mizuki","family":"So","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamina","family":"Miyabayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junya","family":"Tsuzaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seishi","family":"Nakatsuka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Okubo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihisa","family":"Sakurada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Asakura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Jinzaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7669-4166","authenticated-orcid":false,"given":"Masanori","family":"Inoue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"issue":"1","key":"780_CR1","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1378\/chest.12-0526","volume":"143","author":"GJ Nadolski","year":"2013","unstructured":"Nadolski GJ, Itkin M. Thoracic duct embolization for nontraumatic chylous effusion: experience in 34 patients. Chest. 2013;143(1):158\u201363. https:\/\/doi.org\/10.1378\/chest.12-0526.","journal-title":"Chest"},{"issue":"4","key":"780_CR2","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1007\/s12185-022-03397-7","volume":"116","author":"A Fukumoto","year":"2022","unstructured":"Fukumoto A, Terao T, Kuzume A, et al. Management of lymphoma-associated chylothorax by interventional radiology and chemotherapy: a report of five cases. Int J Hematol. 2022;116(4):579\u201385. https:\/\/doi.org\/10.1007\/s12185-022-03397-7.","journal-title":"Int J Hematol"},{"issue":"4","key":"780_CR3","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1053\/j.tvir.2016.10.008","volume":"19","author":"G Nadolski","year":"2016","unstructured":"Nadolski G. Nontraumatic chylothorax: diagnostic algorithm and treatment options. Tech Vasc Interv Radiol. 2016;19(4):286\u201390. https:\/\/doi.org\/10.1053\/j.tvir.2016.10.008.","journal-title":"Tech Vasc Interv Radiol"},{"issue":"2","key":"780_CR4","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1016\/j.jvir.2017.10.006","volume":"29","author":"PH Kim","year":"2018","unstructured":"Kim PH, Tsauo J, Shin JH. Lymphatic interventions for chylothorax: a systematic review and meta-analysis. J Vasc Interv Radiol. 2018;29(2):194-202.e4. https:\/\/doi.org\/10.1016\/j.jvir.2017.10.006.","journal-title":"J Vasc Interv Radiol"},{"issue":"6","key":"780_CR5","doi-asserted-by":"publisher","first-page":"1402","DOI":"10.1016\/j.chest.2022.06.012","volume":"162","author":"A Agrawal","year":"2022","unstructured":"Agrawal A, Chaddha U, Kaul V, Desai A, Gillaspie E, Maldonado F. Multidisciplinary management of chylothorax. Chest. 2022;162(6):1402\u201312. https:\/\/doi.org\/10.1016\/j.chest.2022.06.012.","journal-title":"Chest"},{"key":"780_CR6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvssci.2026.100425","author":"T Maruyama","year":"2026","unstructured":"Maruyama T, Kariya S, Nakatani M, et al. Thoracic duct outflow obstruction increases thoracic duct pressure above central venous pressure supporting thoracic duct decompression. J Vasc Surg Sci. 2026. https:\/\/doi.org\/10.1016\/j.jvssci.2026.100425.","journal-title":"J Vasc Surg Sci"},{"issue":"5","key":"780_CR7","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1513\/AnnalsATS.202103-262OC","volume":"19","author":"A Gurevich","year":"2022","unstructured":"Gurevich A, Hur S, Singhal S, et al. Nontraumatic chylothorax and chylopericardium: diagnosis and treatment using an algorithmic approach based on novel lymphatic imaging. Ann Am Thorac Soc. 2022;19(5):756\u201362. https:\/\/doi.org\/10.1513\/AnnalsATS.202103-262OC.","journal-title":"Ann Am Thorac Soc"},{"issue":"3","key":"780_CR8","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.220231","volume":"307","author":"J Benjamin","year":"2023","unstructured":"Benjamin J, O\u2019Leary C, Hur S, Gurevich A, Klein WM, Itkin M. Imaging and Interventions for Lymphatic and Lymphatic-related Disorders. Radiology. 2023;307(3):e220231. https:\/\/doi.org\/10.1148\/radiol.220231.","journal-title":"Radiology"},{"issue":"5","key":"780_CR9","doi-asserted-by":"publisher","first-page":"1222","DOI":"10.3348\/jksr.2019.0189","volume":"81","author":"H Lee","year":"2020","unstructured":"Lee H, Kwon H, Jeon CH, Kim CW. Direct percutaneous needle puncture and intrapulmonary lymphatic embolization for treatment of chylothorax in a patient with lymphoma. Taehan Yongsang Uihakhoe Chi. 2020;81(5):1222\u20136. https:\/\/doi.org\/10.3348\/jksr.2019.0189.","journal-title":"Taehan Yongsang Uihakhoe Chi"}],"container-title":["CVIR Endovascular"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42155-026-00780-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s42155-026-00780-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42155-026-00780-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:01:52Z","timestamp":1790744512000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s42155-026-00780-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":9,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["780"],"URL":"https:\/\/doi.org\/10.1186\/s42155-026-00780-x","relation":{},"ISSN":["2520-8934"],"issn-type":[{"value":"2520-8934","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"assertion":[{"value":"18 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This case report was conducted in accordance with the Declaration of Helsinki. Written informed consent for participation was obtained from the patient.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and any accompanying images.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"126"}}