Minimal Lymphatic Leakage in an Infant With Chylothorax Detected by Lymphoscintigraphy SPECT/CT abstract A 7-month-old girl with history of persistent left chylous pleural effu-

A 7-month-old girl with history of persistent left chylous pleural effusion was referred for lymphoscintigraphy. A previous chest computed tomography (CT) scan demonstrated a small to moderate-sized left pleural effusion but could not identify the lymphatic leakage site. Lymphoscintigraphy using filtered Tc sulfur colloid showed minimal focal activity in the lower chest. A correlative single-photon emission computed tomography (SPECT)/CT localized this activity to distal paraesophageal region, being highly suggestive of the site of lymphatic leakage. Subsequent lymphangiography confirmed these findings, revealing an abnormal lymphatic branch at the level of T10 and T11 vertebrae with retrocrural extravasation toward the left hemithorax. Thoracic duct embolization was accomplished at and proximal to the site of chyle leak using a platinum coil and n-Butyl cyanoacrylate glue. The patient was followed up for .24 months and demonstrated no recurrence of pleural effusion. No ascites or other complications related to the procedure were noted. The case demonstrates that Tc sulfur colloid lymphoscintigraphy SPECT/CT can be a useful modality for detecting the chyle leakage site in children with chylothorax even when the amount of leakage is minimal. Pediatrics 2014;134:e606–e610 AUTHORS: Jigang Yang, MD, PhD,ab Ion Codreanu, MD, PhD,b,c and Hongming Zhuang, MD, PhDb aDepartment of Nuclear Medicine, Beijing Friendship Hospital of Capital Medical University, Beijing, China; bDepartment of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and cDepartment of Radiology, Medpark International Hospital, State University of Medicine and Pharmacy Nicolae Testemitanu, Chisinau, Moldova