fig2

Figure 2. MR-lymphangiography^[35](A: non-contrast; B: contrast-enhanced) shows a massive dilatation of the TD and stenosis in the mediastinum (white arrows) with consecutive extensive chylolymphatic reflux into phrenic, pancreatic, and periportal lymphvessels (arrow heads). Observe also the bilateral pleural effusion (right > left); C: X-ray lymphangiography confirms dilatation and stenosis of the TD and reflux in the upper abdomen (a–c University Hospital Bonn, Department of Diagnostic and Interventional Radiology); D: The TD was ligated, and the caudal stump (white asterisk) was anastomosed end-to-end to the left phrenic vein (black asterisk); E: At 1-year follow-up, the patient is still asymptomatic with only marginal bilateral costophrenic angle effusion, and F: an inconspicuous abdominal scar.