Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3663_Библиотеки_им_академика_М_И_Перельмана

A 40-year-old woman with complex LAM requiring bilateral lung transplants presented with worsening chylous ascites. Dynamic contrast-enhanced MR lymphangiography identied a lymphatic leak near a pelvic lymphatic mass (Fig.101.1), and she was referred for lymphatic emboliza­tion. Leakage was conrmed on percutaneous intranodal inguinal lymphangiography (Fig.101.2). The mass was then accessed transabdominally under uoroscopic guidance, and needle position was conrmed using water soluble contrast before embolization was performed (Fig. 101.3). During embolization, glue extravasated into the common iliac vein and migrated into the right pulmonary artery (Fig. 101.4). The patient remained hemodynamically stable, but a deci­sion for urgent retrieval was made due to the embolus size and central location. The right common femoral vein was accessed, a vascular sheath was positioned in the IVC, and the embolus was retrieved in its entirety with a snare (Figs. 101.5a–c and 101.6). No post-procedure complica­tions occurred. The patient was ultimately relieved of her symptoms after additional embolizations and percutaneous drainages over 18months.