Fig. 2

Intra-procedural findings. Lymphangiogram after ethiodol injection into a groin lymph node (a) revealed abnormal dilated and tortuous lymphatic channels in the right iliac chain. Fluoroscopic image (b) of the upper chest demonstrated a partially opacified thoracic duct terminating abruptly at the inferior margin (black arrow) and multiple abnormal, irregular lymphatic channels (white arrow) in the mediastinum corresponding to the CT image in Fig. 1. The abrupt termination was likely due to a valve. This was crossed without much difficulty with a microsystem. Grayscale ultrasound image (c) of the thoracic duct (white arrow) draining into the left subclavian vein (black arrow) at the venous angle. Intra-procedural fluoroscopic image (d) of the thoracic duct demonstrating embolization coils (white arrows) at the inferior and superior aspects of the duct. The intervening segment of thoracic duct was embolized with radiopaque NBCA (black arrows). A left chest tube and right PICC are present