Magnetic resonance–thoracic ductography can guide precise location and ligation of thoracic duct fistulas for patients with postoperative chylothorax: case series and literature review

Abstract Postoperative chylothorax is a rare complication after thoracic surgery, characterized by the pathological accumulation of chyle within the pleural space. It typically results from intraoperative injury to the thoracic duct. The management of chylothorax remains controversial, particularly in cases that do not respond to conservative treatment strategies. Thoracic duct ligation has been considered the primary therapeutic option for patients with refractory chylothorax. Thoracic duct ligation is a primary treatment for refractory chylothorax. However, in some cases, the procedure may fail or even exacerbate the condition. This failure may potentially be attributed to inaccurate ligation of thoracic duct fistulas or the presence of anatomical variations. Hence, we propose an approach to enhance the precision of thoracic duct ligation: magnetic resonance–thoracic ductography (MRTD). In this case series, we describe the use of MRTD in four patients with postoperative chylothorax who failed conservative management. Preoperative MRTD imaging was employed to locate the thoracic duct fistulas. With guidance from MRTD, all patients underwent successful ligation of thoracic duct. Our findings suggest that MRTD offers a non-invasive approach that enables rapid and accurate localization of thoracic duct fistulas, thereby facilitating precise ligation.