Thoracic duct embolization (TDE)

Thoracic duct embolization (TDE) is a procedure to treat a leak in the thoracic duct of your lymphatic system. The leak can cause fluid buildup between your chest and lung, a condition known as chylothorax. TDE is a minimally invasive way to treat this condition and relieve symptoms like cough, breathlessness, and chest pain.

At the Penn Center for Lymphatic Diseases and Lymphedema, we’re one of the few practices in the nation with specialized expertise in the lymphatic system. Our interventional radiologists pioneered chylothorax treatment and have refined the technique over the last 20 years, giving us a cure rate of close to 100 percent. TDE isn’t available everywhere, but our doctors have the skill and experience to help you feel better while avoiding open surgery.

Chylothorax occurs when there’s damage to your thoracic duct or its branches, the main lymph vessel in your lymphatic system. This might happen due to injury, surgery, or certain conditions. The damage can allow fluid, called chyle, to leak into the cavity between your chest and lung. Chyle is a type of lymph fluid that includes fats and immune cells.

If you’ve been diagnosed with chylothorax, your doctor may recommend that you try other treatments before considering TDE. If they aren’t effective, thoracic duct embolization can seal the leak.

Before your procedure, your health care team will give you instructions on how to prepare, including whether you need to stop taking certain medications before surgery and when to begin fasting. On the day of the procedure, you’ll be given anesthesia and sedation to help you feel relaxed.

The first step of the procedure is a specialized imaging test that shows the vessels of your lymphatic system and how lymph fluid moves through them, like intranodal lymphangiography or magnetic resonance lymphangiography. Then your doctor advances a hollow tube called a catheter through your vessels to inject contrast dye directly into your thoracic duct. Using real-time x-rays (fluoroscopy), your doctor finds the source of the leak and seals it with surgical glue, coils, or plugs.

After surgery, you may feel sore where the doctor punctured your skin. Your health care team will monitor you in a recovery room, and you may need to stay in the hospital for a day or two so that your doctor can make sure the leak has stopped. When it’s time to leave the hospital, you'll receive guidelines on how to gradually return to your normal activities.

The Penn Center for Lymphatic Diseases and Lymphedema is a Lymphatic Education & Research Network (LE&RN) Center of Excellence for high standards of care, research, and education. In addition to our clinical experience, our researchers have led the way in the study of chylothorax. This includes determining its cause from leaks in the thoracic duct into the space around the lungs (chylous leaks). Our doctors have also been at the forefront of treatment, including performing the thoracic duct embolization technique. With our expertise and knowledge, you can trust that you’ll receive precision treatment to ease your symptoms.