Lymphatic Leaks: Georgia's Story

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Georgia, 10, and her family were enjoying an ATV tour on their first day of vacation in Montana when tragedy struck. While going through a tunnel, the ATV suddenly veered up the side of the tunnel, flipped over and came crashing down on top of Georgia.

Georgia smiling A friend who was vacationing with the family helped lift the 3,000-pound vehicle off of Georgia, who was unconscious. An ambulance was called and Georgia was rushed to a nearby hospital, with her father, Rick, by her side and her mother, Marti, following close behind. There, X-rays showed she had five broken ribs and a broken collar bone (clavicle), as well as severe bruising, contusions to the lungs and symptoms of concussion.

Initially, Georgia appeared to be recovering well, but then she began having difficulty breathing. Further diagnostic testing was done and physicians found Georgia’s right lung was completely filled with fluid, and her left lung was partially filled with fluid. She needed an emergent procedure to drain the fluid.

Doctors inserted chest tubes to drain the fluid in Georgia's lungs. Two days after the procedure, the fluid level in Georgia’s left lung had decreased, but the fluid in her right lung increased and had changed colors.

A significant lymphatic leak

Doctors tested the fluid in Georgia's right lung and discovered it was chyle, indicating it was fluid from the lymphatic system, which meant that Georgia had a leak in her lymphatic system.

Georgia's family, along with friends in the medical community, researched Georgia’s condition. Everyone they spoke with recommended Yoav Dori, MD, PhD, a cardiologist and Director of the Center for Lymphatic Imaging and Interventions at Children’s Hospital of Philadelphia (CHOP). The center, a joint program of CHOP and the Hospital of the University of Pennsylvania (HUP), developed an innovative procedure for imaging and shutting down lymphatic leaks.

The experts told us Dr. Dori was the only person in the country who could handle this.

The family reached out to the Cardiac Center Nurse Navigators at CHOP who connected with the transport team. After reviewing Georgia’s records and imaging, Erin Pinto, MSN, RN, a nurse practitioner in the Center for Lymphatic Imaging and Interventions, and the Lymphatics team advised the medical team in Montana of how to care for Georgia until the transfer could be finalized.

Air transport to Philadelphia

Once the transport process was finalized, Georgia was on a medical flight to Philadelphia accompanied by two nurses and her father. Her mother followed on commercial flight the same day.

When Georgia arrived at CHOP, the inpatient team got right to work with a full medical workup, imaging and examinations by a multidisciplinary team including neurology, cardiology and ophthalmology.

For the next few days, Georgia was restricted to a fat-free diet to decrease the flow of lymphatic fluid. Despite that, her right lung continued to drain copious amounts of fluid.

An innovative procedure

After reviewing all of Georgia's test results, Dr. Dori met with Georgia's family to discuss a treatment plan. He used diagrams of the lymphatic system to explain how he planned to use dynamic contrast MR lymphangiography (DCMRL), an advanced imaging test, to confirm the location of Georgia’s leaks. He would then perform a minimally invasive procedure called thoracic duct embolization to stop the flow of chyle that was leaking into her lungs. There would be no incision for the procedure, but only small puncture sites on the abdomen that would be able to stop the leak.

Dr. Dori performed the procedure the next day, and all went as planned. The chest tube remained in place to drain additional fluid remaining in her lungs.

“After the procedure, Dr. Dori showed us images of the leak before and after,” Rick says. “We could see it leaking before and then not leaking. He was very confident, very positive that he had found and closed the leak.”

Dr. Dori had also discovered the cause of the leak. The injury to Georgia's clavicle had created a significant gash — right above her heart — that had torn the thoracic duct.

Success in closing the leak

“The decrease in fluid output was incredible,” Rick says. “And on the second day it dropped off even more.”

By the third day, Georgia was ready for the “fat challenge” — a meal high in fat to increase the production of lymphatic fluid. She ordered a burger from a local restaurant. “It tasted like heaven between two rolls,” Georgia remembers.

The meal did not cause an increase in fluid or change in coloring of the output through the drain. The leak was fixed.

For the next two weeks, Georgia needed to keep lymphatic production low while her lymphatic system opened up new lymphovenous connections to handle her lymphatic flow now that her thoracic duct was embolized. So, after the burger, she resumed her low-fat diet. When it was safe to eat normally again, Rick treated his daughter to a home-grilled hamburger with avocado for breakfast.

Georgia was home by then. Her lymphatic leak had been successfully closed.

While the most serious of her medical issues was resolved, Georgia still had to recover from other issues related to the accident. For example, she was often tired and dizzy due to the concussion she sustained.

When she returned to school at the end of September, she attended for just an hour a day and gradually built up her mental endurance. By mid-October, she was back in school full time.

Back riding horses

Georgia wearing her equestrian helmet In spring 2018, Georgia was cleared to ride horses again. It's her biggest passion, and she had missed it terribly during the year following her accident. She competed in a horse show in June, and now rides and works at the barn every week. On vacation in South Carolina with her family this summer she swam, took surfing lessons and enjoyed a two-hour horseback ride on the beach.

Georgia also enjoys acting — she was Baby Shrek in a recent production — and special effects makeup, which she practices on herself.

“The care the medical team showed Georgia was amazing,” says Rick.

"It was so comforting to be in the hands of a team of pioneers," Marti adds.

We are forever grateful for people who are able to think outside the box and come up with innovative treatments like this..

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