Interventional and Surgical Management of Chylothorax, Chylous Ascites, Post-Operative Lymphocele, Plastic Bronchitis and Protein-Losing Enteropathy: A Narrative Review

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Acquired lymphatic flow disorders include chylothorax, plastic bronchitis, chylous ascites, protein-losing enteropathy, and post-operative lymphocele. These heterogenous clinical entities share common mechanisms and pathophysiology: disruption to normal antegrade flow of lymphatic fluid. Advances in imaging and interventional techniques have improved physicians’ ability to diagnose and treat these diseases. Workup with computed tomography, heavily T2-weighted MRI, and dynamic contrast-enhanced magnetic resonance lymphangiography can elucidate etiologies and provide targets for intervention. Initial management consists of very-low fat diets, medium chain triglyceride supplementation, and pharmacologic therapy with somatostatin analogs. If conservative management fails, interventions like thoracic duct embolization, thoracic duct stent-grafting and decompression, transjugular intrahepatic porto-systemic shunting, and lymphatic channel embolization offer novel, minimally invasive options, with surgery reserved for refractory cases. Future investigations will establish long-term outcomes after thoracic duct embolization, elucidate the relative benefit of thoracic duct embolization versus stent-grafting, and establish standardized treatment algorithms for post-operative lymphocele. In this review, we discuss the etiologies, workup, diagnosis, and management of acquired lymphatic flow disorders.