Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. X:X | DOI: 10.5507/bp.2026.019

Thoracic duct stenting as a treatment for chylothorax and chylous ascites in patient with Yellow nail syndrome

Vendelin Chovanec1, 2, Pavol Viglas1, 3, Jan Raupach1, 2, Filip Cihlar3, Ivo Hanke1, 4, Pavel Ryska1, 2
1 Department of Radiology, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Simkova 870, 500 03, Hradec Kralove, Czech Republic
2 Department of Radiology, University Hospital Hradec Kralove, Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic
3 Department of Radiology, Masaryk Hospital, J.E. Purkinje University and KZ a.s., Usti nad Labem, Socialni pece 12A, Usti nad Labem, Czech Republic
4 Department of Cardiosurgery, University Hospital Hradec Kralove, Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic

Purpose. To report the approach, technical success, safety, and short-term outcomes of thoracic duct stenting for treating chylothorax and chylous ascites in a patient with Yellow Nail Syndrome.

Case report: A 57-year-old male with Yellow Nail Syndrome, characterized by yellow thickened nails, lymphedema, and respiratory abnormalities, required repeated thoracocenteses for chylothorax. A thoracic duct intervention involving percutaneous transluminal angioplasty and balloon-expandable stent implantation via retrograde access was performed. Procedure characteristics, clinical success, complications, and follow-up were recorded.

Conclusions: Thoracic duct stenting was a safe and technically successful procedure. After the procedure, the patient was relieved of symptoms. This technique could be considered for patients with recurrent chylothorax and chylous ascites, including those with Yellow Nail Syndrome. Further research is required to validate these findings.

Keywords: Yellow Nail Syndrome, ductus thoracicus stenting, chylous ascites, chylothorax, thoracic duct decompression

Received: March 14, 2026; Revised: May 15, 2026; Accepted: June 29, 2026; Prepublished online: July 14, 2026 

Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Samman PD, White WF. The Yellow Nail Syndrome. Br J Dermatol 1964;76(4):153-7. Go to original source...
    2. Vignes S, Baran R. Yellow nail syndrome: a review. Orphanet J Rare Dis 2017;12(1):42. doi: 10.1186/s13023-017-0594-4 Go to original source... Go to PubMed...
    3. Bull RH, Fenton DA, Mortimer PS. Lymphatic function in the yellow nail syndrome. Br J Dermatol 1996;134(2):307-12. doi: 10.1111/j.1365-2133.1996.tb07619 Go to original source...
    4. Maldonado F, Ryu JH. Yellow nail syndrome. Curr Opin Pulm Med 2009;15(4):371-5. doi: 10.1097/MCP.0b013e32832ad45a Go to original source... Go to PubMed...
    5. Tanaka E, Matsumoto K, Shindo T, Taguchi Y. Implantation of a pleurovenous shunt for massive chylothorax in a patient with yellow nail syndrome. Thorax 2005;60(3):254-5. doi: 10.1136/thx.2003.015925 Go to original source...
    6. Lambert E, Dziura J, Kauls L, Mercurio M, Antaya R. Yellow nail syndrome in three siblings: a randomized double-blind trial of topical vitamin E. Pediatr Dermatol 2006;23(4):390-5. doi: 10.1111/j.1525-1470.2006.00251 Go to original source...
    7. Matsubayashi S, Suzuki M, Suzuki T, Shiozawa A, Kobayashi H, et al. Effectiveness of clarithromycin in patients with yellow nail syndrome. BMC Pulm Med 2018;18(1):80. doi: 10.1186/s12890-018-0707-4 Go to original source... Go to PubMed...
    8. Tosti A, Piraccini BM, Iorizzo M. Systemic itraconazole in the yellow nail syndrome. Br J Dermatol 2002;146(6):1064-7. doi: 10.1046/j.1365-2133.2002.04671.x Go to original source...
    9. Woodfield G, Nisbet M, Jacob J, Mok W, Loebinger MR, Hansell DM, et al. Bronchiectasis in yellow nail syndrome. Respirology 2017;22(1):101-7. doi: 10.1111/resp.12866 Go to original source... Go to PubMed...
    10. Brooks KG, Echevarria C, Cooper D, Bourke SC. Somatostatin analogues in yellow nail syndrome associated with recurrent pleural effusions. Thorax 2014;69(10):967-8. doi: 10.1136/thoraxjnl-2014-205426 Go to original source... Go to PubMed...
    11. Balmforth D, Bille A, Okiror L, Harrison-Phipps K, Routledge T. Recurrent pleural effusion in yellow nail syndrome successfully treated with video-assisted thoracic surgery: comparison of two surgical strategies in two cases. Gen Thorac Cardiovasc Surg 2013;61(4):231-3. doi: 10.1007/s11748-012-0125-0 Go to original source... Go to PubMed...
    12. Wong S, Wang M, Hirji A, Li P. Management of chylothorax and chylous ascites due to yellow nail syndrome with indwelling catheters: a case report. AME Med J 2025;10:18. doi: 10.21037/amj-23-212 Go to original source...
    13. Glazer M, Berman N, Lafair JS, Kramer MR. Successful talc slurry pleurodesis in patients with nonmalignant pleural effusion. Chest 2000;117(5):1404-9. Go to original source...
    14. Taguchi M, Masuk H, Kawashima K, Yamagishi T, Kitaoka Y, Shigemasa R, Yoshida K, Tsurushige C, Satoh H, Hizawa N. Control of pleural effusion with prednisolone in a patient with yellow nail syndrome: a case report. Exp Ther Med 2024;27(4):224. doi: 10.3892/etm.2024.12512 Go to original source...
    15. Lasinski BB, McKillip Thrift K, Squire D, Austin MK, Smith KM, Wanchai A, Green JM, Stewart BR, Cormier JN, Armer JM. A systematic review of the evidence for complete decongestive therapy in the treatment of lymphedema from 2004 to 2011. PM R 2012;4(8):580-601. doi: 10.1016/j.pmrj.2012.05.003 Go to original source...
    16. Tan WC. Dietary treatment of chylous ascites in yellow nail syndrome. Gut 1989;30(11):1622-3. Go to original source...
    17. Widjaja A, Gratz KF, Ockenga J, Wagner S, Manns MP. Octreotide for therapy of chylous ascites in yellow nail syndrome. Gastroenterology 1999;116(4):1017-8. Go to original source...
    18. Makrilakis K, Pavlatos S, Giannikopoulos G, Toubanakis C, Katsilambros N. Successful octreotide treatment of chylous pleural effusion and lymphedema in the yellow nail syndrome. Ann Intern Med 2004;141(3):246-7. doi: 10.7326/0003-4819-141-3-200408030-00027 Go to original source...
    19. Lotfollahi L, Abedini A, Darazam IA, Kiani A, Fadaii A. Yellow nail syndrome: report of a case successfully treated with octreotide. Tanaffos 2015;14(1):67-71.
    20. Bhatnagar M, Fisher A, Ramsaroop S, Carter A, Pippard B. Chylothorax: pathophysiology, diagnosis, and management-a comprehensive review. J Thorac Dis 2024;16(2):1645-61. doi: 10.21037/jtd-23-1636 Go to original source...
    21. Agrawal A, Chaddha U, Kaul V, Desai A, Gillaspie EA, Maldonado F. Multidisciplinary management of chylothorax. Chest 2022;162(6):1402-12. doi: 10.1016/j.chest.2022.06.012 Go to original source... Go to PubMed...
    22. Weinzierl A, Grunherz L, Puippe G, Gnannt R, von Reibnitz D, Giovanoli P, Vetter D, Möhrlen U, Wildgruber M, Müller A, Pieper CC, Gutschow CA, Lindenblatt N. Microsurgical central lymphatic reconstruction-the role of thoracic duct lymphovenous anastomoses at different anatomical levels. Front Surg 2024;11:1415010. doi: 10.3389/fsurg.2024.1415010 Go to original source...
    23. Thamm OC, Eschborn J, Schafer R, Schmidt J. Advances in modern microsurgery. J Clin Med 2024;13(17):5284. doi: 10.3390/jcm13175284 Go to original source... Go to PubMed...
    24. Cope C, Kaiser LR. Management of unremitting chylothorax by percutaneous embolization and blockage of retroperitoneal lymphatic vessels in 42 patients. J Vasc Interv Radiol 2002;13(11):1139-48. doi: 10.1016/s1051-0443(07)61956-3 Go to original source...
    25. Pier JL, Rashid MA. Thoracic duct injury. J Cardiothorac Trauma 2021;6(1):15-21. doi: 10.4103/jctt.jctt_19_21 Go to original source...
    26. Nadolski GJ, Itkin M. Feasibility of ultrasound-guided intranodal lymphangiogram for thoracic duct embolization. J Vasc Interv Radiol 2012;23(5):613-6. doi: 10.1016/j.jvir.2012.01.078 Go to original source...
    27. Kim PH, Tsauo J, Shin JH. Lymphatic interventions for chylothorax: a systematic review and meta-analysis. J Vasc Interv Radiol 2018;29(2):194-202.e4. doi: 10.1016/j.jvir.2017.10.006 Go to original source...
    28. Cope C. Management of chylothorax via percutaneous embolization. Curr Opin Pulm Med 2004;10(4):311-4. doi: 10.1097/01.mcp.0000127903.45446.6d Go to original source...
    29. Srinivasa RN, Chick JF, Hage AN, Gemmete JJ, Murrey DC, Srinivasa RN. Endolymphatic thoracic duct stent-graft reconstruction for chylothorax: approach, technical success, safety, and short-term outcomes. Ann Vasc Surg 2018;48:97-103. doi: 10.1016/j.avsg.2017.11.031 Go to original source...
    30. Ghelfi J, Brusset B, Teyssier Y, Sengel C, Gerster T, Girard E, Roth G, Bellier A, Bricault I, Decaens T. Endovascular lymphatic decompression via thoracic duct stent placement for refractory ascites in patients with cirrhosis: a pilot study. J Vasc Interv Radiol 2023;34(2):212-7. doi: 10.1016/j.jvir.2022.10.030 Go to original source...
    31. Chick JF, Reddy S, Murrey A, Castle JC, Gemmete JJ, Saad WE, Srinivasa RN. Single-session endolymphatic thoracic duct stent-graft placement for recurrent idiopathic chylothorax. J Vasc Interv Radiol 2017;28(7):1063-7. doi: 10.1016/j.jvir.2017.02.023 Go to original source...
    32. Cuong NN, Linh LT, My TT, Hoa TQ, Long H, Hoan L, Inoue M. Management of chyluria using percutaneous thoracic duct stenting. CVIR Endovasc 2022;5(1):42. doi: 10.1186/s42155-022-00333-y Go to original source... Go to PubMed...

    This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return