What are the methods for testing for a chyle (lymphatic fluid) leak?

From the Guidelines

Chyle leak testing methods include pleural fluid analysis and imaging studies. The diagnosis of a chyle leak is typically confirmed by the presence of chylomicrons in the pleural fluid, with a pleural fluid triglyceride level > 110 mg/dL and a ratio of pleural fluid to serum triglyceride level of >1.0 being diagnostic criteria 1.

Methods for testing for a chyle leak

• Pleural fluid analysis:
  • Triglyceride level > 110 mg/dL
  • Ratio of pleural fluid to serum triglyceride level of >1.0
  • Ratio of pleural fluid to serum cholesterol level of <1.0
• Imaging studies:
  • Conventional lymphangiography: considered the gold standard for visualization of lymph nodes, lymphatic vessels, cisterna chyli, and the thoracic duct, and for detection of lymphatic leakage 1
  • Nuclear lymphoscintigraphy: may be used to identify draining lymph nodes and visualize the anatomic configuration of the thoracic duct, but its routine use is not well supported by literature 1
  • CT and MRI: may be used to visualize the thoracic duct and cisterna chyli, and to identify the cause and location of the leak, especially when combined with lymphangiography 1

Additional testing methods

• Increasing fatty intake: may increase the volume and change the color of the fluid, aiding in diagnosis 1
• Thoracentesis: may be used to drain the fluid for studies and to palliate symptoms 1

From the Research

Methods for Testing Chyle Leaks

The following methods are used to test for chyle leaks:

• Lymphangiography (LAG) with or without postprocedure computed tomography (CT) imaging 2, 3, 4
• Lymphangiography with lipiodol as a diagnostic and therapeutic approach 3
• Conservative management with diet modifications, such as a low-fat medium-chain triglyceride diet, total parenteral nutrition, and insertion of a drainage tube 5, 4, 6
• Surgical re-exploration of the axilla and oversewing of the chyle duct as a last resort for persistent chyle leaks 6

Diagnostic Approaches

Diagnostic approaches for chyle leaks include:

• Bipedal lymphangiography (LAG) to identify and localize the source of the chyle leak 2
• Postprocedure CT imaging to provide additional diagnostic information and fine anatomic localization of the chyle leak 2
• Lymphangiography with lipiodol to diagnose and treat chyle leaks 3

Effectiveness of Lymphangiography

Lymphangiography has been shown to be effective in:

• Detecting the chyle leakage sites in 78% of patients 4
• Stopping lymphatic leakage in 89% of patients 4
• Avoiding surgical re-intervention in most cases 4