Cervical thoracic duct cyst: treatment options beyond resection

Problems: A 48-year-old female patient presented with a left cervical thoracic duct cyst. Most previous reports on thoracic duct cysts have described open surgery with excision and ligation. However, less invasive treatment methods have proven effective. Methodology: Here, we describe a thoracic duct cyst that was refractory to aspiration or upstream clipping of the thoracic duct via video-assisted thoracoscopic surgery (VATS). Eventually, we performed percutaneous sclerotherapy with OK432 (Picibanil). Analysis of a fine-needle aspirate of the cystic mass confirmed the diagnosis. Results: Minimally invasive management with sclerotherapy completely resolved the cyst. Conclusions: Thoracic duct cysts can be treated successfully with a non-surgical sclerotherapy approach. Clipping the thoracic duct via VATS can prevent chyle accumulation in the thoracic duct cyst and resolve chyle leakage. Consequently, an open surgical approach can be avoided, but remains optional, in case minimally invasive management is unsuccessful.