{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T20:04:24Z","timestamp":1793736264810,"version":"4.6.1"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2022,5,1]],"date-time":"2022-05-01T00:00:00Z","timestamp":1651363200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Outcomes of interventional lymphangiographic treatment of nontraumatic chylous pleural effusions using traditional approaches have been highly variable. Recent advances in lymphatic imaging have revealed variations in underlying pathophysiology, enabling improved targeting of therapeutic interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess outcomes of an algorithm for management of nontraumatic chylous pleural effusions based on advanced magnetic resonance (MR) identification of various abnormalities in the thoracoabdominal lymphatic network that give rise to chylothorax.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Novel lymphatic MR imaging was performed in 52 patients aged 11\u201389 years. Three distinct pathophysiological patterns were found: 1) abnormal pulmonary lymphatic flow from the thoracic duct only; 2) abnormal pulmonary lymphatic flow from retroperitoneal lymphatic networks with or without involvement of the thoracic duct; and 3) chylous ascites presenting as chylous pleural effusion. Lymphatic interventions were individualized to the underlying pathophysiological patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 41\/52 (79%) patients, imaging revealed abnormal pulmonary lymphatic flow from the thoracic duct and\/or retroperitoneal lymphatic networks. Thoracic duct embolization and\/or interstitial embolization of retroperitoneal lymphatic resulted in resolution of chylothorax in this group in 38\/41 (93%) of those patients. Five patients experienced grade 1 or 2 complications. One patient succumbed to postoperative stress-induced cardiomyopathy and pulmonary embolism. Chylous ascites was the cause of chylothorax in 11\/52 (21%) patients. Eight chose to undergo interventions for chylous ascites with clinical success in 6\/8 (75%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Application of magnetic resonance imaging-guided intervention algorithm resulted in successful control of nontraumatic chylothorax in 93% patients with abnormal pulmonary lymphatic flow. Appropriate treatment of chylous ascites presenting as a pleural effusion requires systematic evaluation and diagnosis prior to potential treatments.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1513\/annalsats.202103-262oc","type":"journal-article","created":{"date-parts":[[2021,11,19]],"date-time":"2021-11-19T15:10:55Z","timestamp":1637334655000},"page":"756-762","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":30,"title":["Nontraumatic Chylothorax and Chylopericardium: Diagnosis and Treatment Using an Algorithmic Approach Based on Novel Lymphatic Imaging"],"prefix":"10.1093","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8031-2028","authenticated-orcid":false,"given":"Alexey","family":"Gurevich","sequence":"first","affiliation":[{"name":"Division of Interventional Radiology, Department of Radiology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saebeom","family":"Hur","sequence":"additional","affiliation":[{"name":"Department of Radiology, Seoul National University Hospital, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil","family":"Singhal","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"DiBardino","sequence":"additional","affiliation":[{"name":"Pulmonary, Allergy, and Critical Care Division, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew R.","family":"Haas","sequence":"additional","affiliation":[{"name":"Pulmonary, Allergy, and Critical Care Division, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John H.","family":"Hansen-Flaschen","sequence":"additional","affiliation":[{"name":"Pulmonary, Allergy, and Critical Care Division, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Nadolski","sequence":"additional","affiliation":[{"name":"Center for Lymphatic Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxim","family":"Itkin","sequence":"additional","affiliation":[{"name":"Center for Lymphatic Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,5,1]]},"reference":[{"key":"2026012203314654200_bib1","doi-asserted-by":"crossref","first-page":"867","DOI":"10.4065\/80.7.867","article-title":"Etiology of chylothorax in 203 patients","volume":"80","author":"Doerr","year":"2005","journal-title":"Mayo Clin Proc"},{"key":"2026012203314654200_bib2","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1378\/chest.12-0526","article-title":"Thoracic duct embolization for nontraumatic chylous effusion: experience in 34 patients","volume":"143","author":"Nadolski","year":"2013","journal-title":"Chest"},{"key":"2026012203314654200_bib3","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1002\/pbc.25914","article-title":"Clinical features and prognosis of generalized lymphatic anomaly, kaposiform lymphangiomatosis, and Gorham-Stout disease","volume":"63","author":"Ozeki","year":"2016","journal-title":"Pediatr Blood Cancer"},{"key":"2026012203314654200_bib4","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1378\/chest.114.1.154","article-title":"Chylothorax in cirrhosis of the liver: analysis of its frequency and clinical characteristics","volume":"114","author":"Romero","year":"1998","journal-title":"Chest"},{"key":"2026012203314654200_bib5","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.ejcts.2007.04.024","article-title":"Aetiology and management of chylothorax in adults","volume":"32","author":"Nair","year":"2007","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026012203314654200_bib6","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1159\/000093499","article-title":"Compartimentalization for chylothorax originating from the abdomen after extended esophagectomy. 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