# Lymphovenous anastomosis for recurrent swelling syndrome and chylous effusion due to cervical thoracic duct cyst

Julie Veziant, Laurent Sakka, Géraud Galvaing, Marie M Tardy, Lucie Cassagnes, Marc Filaire

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## ► To cite this version:

Julie Veziant, Laurent Sakka, Géraud Galvaing, Marie M Tardy, Lucie Cassagnes, et al. Lymphovenous anastomosis for recurrent swelling syndrome and chylous effusion due to cervical thoracic duct cyst. Journal of Vascular Surgery, 2015, 62 (4), pp.1068 - 1070. 10.1016/j.jvs.2014.02.060. hal-05488745

HAL Id: hal-05488745

https://uca.hal.science/hal-05488745v1

Submitted on 4 Feb 2026

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# Lymphovenous Anastomosis for Recurrent Swelling Syndrome and Chylous Effusion Due to Cervical Thoracic Duct Cyst

Julie Veziant, MD; Laurent Sakka, MD; Géraud Galvaing, MD; Marie M. Tardy, MD; Lucie Cassagnes, MD; Marc Filaire, MD

Clermont-Ferrand, France

Service de Chirurgie Thoracique, Centre Jean Perrin
Laboratoire d'Anatomie, Clermont Université, Université d'Auvergne
Unité de Nutrition Humaine, Clermont Université
Service de Radiologie, CHU Clermont-Ferrand

## ABSTRACT

Thoracic duct cyst is an uncommon abnormality that can be manifested as cervical swelling. Diagnosis is crucial to eliminate malignant disease or vein thrombosis.

We report a case of recurrent cervical swelling with spontaneous chylothorax and chyloperitoneum successfully treated by microsurgical lymphovenous anastomosis.

## INTRODUCTION

A supraclavicular mass is common and may arise from infectious disease, branchial cleft cysts, and benign or malignant tumors. Less common causes include lymphatic malformations and thoracic duct cysts, known to cause primary chylous effusion. Recurrent swelling may occur when the malformation is located at the terminal portion of the thoracic duct.
Establishing diagnosis and selecting appropriate therapy may be challenging.

## CASE REPORT

A 49-year-old woman presented with sudden swelling of the left supraclavicular fossa associated with respiratory discomfort and chest pain.

She had no history of trauma or surgery. Physical examination revealed a nontender mass and normal vital signs.

Chest radiograph showed bilateral pleural effusion. Ultrasound showed peritoneal effusion and a hypoechoic cervical mass.

CT scan confirmed a supraclavicular cystic mass, pleural effusion, and peritoneal effusion. Thoracentesis revealed chylous fluid with triglycerides at 2950 mg/dL.
Pedal lymphangiography confirmed a thoracic duct cyst with terminal dilation.

A low-fat diet led to resolution of symptoms. After 10 years of dietary control, symptoms
recurred with minor deviations.

Ultrasound confirmed a cervical cyst without effusions.

Lymphangiography and CT showed cystic dilation with terminal obstruction.

Surgical reconstruction was chosen. A high-fat meal was given preoperatively. A left supraclavicular cervicotomy was performed. A side-to-side lymphovenous anastomosis between the cyst and internal jugular vein was performed using microsurgical technique.

A drain was placed.

Postoperative recovery was uneventful.

The patient resumed a normal diet and received tinzaparin for one month.

Follow-up at 3 months and 3 years showed no recurrence.

DISCUSSION

Cervical thoracic duct cysts are rare. Their pathogenesis remains unclear and may include congenital weakness, degeneration, or obstruction. Diagnosis relies on imaging and needle aspiration.

Lymphangiography remains the gold standard.

Treatment depends on symptoms. Conservative management includes low-fat diet. Surgery is indicated in recurrent symptomatic cases. Lymphovenous anastomosis is a physiological and effective option.

CONCLUSION

Lymphovenous anastomosis is a valuable and well-tolerated technique for treating thoracic duct cysts with terminal obstruction. Imaging and lymphangiography are essential for diagnosis.

CONFLICT OF INTEREST

None declared.

CORRESPONDENCE

Marc Filaire, MD

Centre Jean Perrin, Service de Chirurgie Thoracique

BP 392, F-63011 Clermont-Ferrand, France

Email: marc.filaire@cjp.fr

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