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Medicine Dec 2021The transient occlusion of the terminal thoracic duct is a rare disease responsible for renitent supraclavicular cysts. The aim of this study was to describe the... (Review)
Review
The transient occlusion of the terminal thoracic duct is a rare disease responsible for renitent supraclavicular cysts. The aim of this study was to describe the clinical characteristics, evolution, and treatment.A retrospective multicenter study and literature review was carried out. The literature search (PubMed) was conducted including data up to 31 December 2020 and PRISMA guidelines were respected.This study identified 6 observational cases between September 2010 and December 2020. The search results indicated a total of 24 articles of which 19 were excluded due to the lack of recurrent swelling or the unavailability of full texts (n = 5). Fourteen patients (8 from literature) mostly reported a noninflammatory, painless renitent mass in the supraclavicular fossa which appeared rapidly over a few hours and disappeared spontaneously over an average of 8 days (range: from about 2 hours to 10 days). Anamnesis indicated a high-fat intake during the preceding days in all cases and 7 from literature found in the Medline databases. Recurrences were noted in 10 patients. Thoracic duct imaging was performed in all cases to detect abnormalities or extrinsic compression as well as to eliminate differential diagnoses.A painless, fluctuating, noninflammatory, and recurrent swelling of the left supraclavicular fossa in patients evoking an intermittent obstruction of the terminal portion of the thoracic duct was identified. A low-fat diet was found as safe and effective treatment.
Topics: Aged; Female; Humans; Male; Mediastinal Cyst; Middle Aged; Recurrence; Retrospective Studies; Thoracic Duct; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 34918683
DOI: 10.1097/MD.0000000000028213 -
Medicine Oct 2022Postoperative chylothorax is a rare complication after pulmonary resection. Thoracic duct variations may play a key role in postoperative chylothorax occurrence and make... (Review)
Review
RATIONALE
Postoperative chylothorax is a rare complication after pulmonary resection. Thoracic duct variations may play a key role in postoperative chylothorax occurrence and make treatment difficult. No studies in the literature have reported the successful treatment of chylothorax second to thoracic duct variation by lipiodol-based lymphangiography.
PATIENT CONCERNS
A 63-year-old male and a 28-year-old female with primary lung adenocarcinoma were treated by video-assisted thoracoscopic cancer resection, and suffered postoperative chylothorax. Conservative treatment was ineffective, including nil per os, persistent thoracic drainage, fatty food restriction, and somatostatin administration.
DIAGNOSIS
Postoperative chylothorax.
INTERVENTIONS
Patients received lipiodol-based lymphangiography under fluoroscopic guidance. Iatrogenic injuries were identified at thoracic duct variations, including an additional channel in case 1 and the lymphatic plexus instead of the thoracic duct in case 2.
OUTCOMES
Thoracic duct variations were identified by lipiodol-based lymphangiography, and postoperative chylothorax was successfully treated by lipiodol embolizing effect.
LESSONS
Thoracic duct variations should be considered after the failure of conservative treatment for postoperative chylothorax secondary to pulmonary resection. Lipiodol-based lymphangiography is valuable for identifying the thoracic duct variations and embolizing chylous leakage.
Topics: Male; Female; Humans; Adult; Middle Aged; Chylothorax; Thoracic Duct; Ethiodized Oil; Postoperative Complications; Lymphography; Thoracic Injuries
PubMed: 36316910
DOI: 10.1097/MD.0000000000031383 -
The Journal of Veterinary Medical... Jan 2012A simple method of lymphography of the thoracic duct was investigated. Using three female beagles, contrast media were administered rectally, vaginally and into the...
A simple method of lymphography of the thoracic duct was investigated. Using three female beagles, contrast media were administered rectally, vaginally and into the perianal tissue. The administration sites were gently massaged, and imaging was carried out at constant intervals using computed tomography and radiograph. Moreover, Indian ink was administered into the rectum mucous membrane in dogs for proof of this method of lymphography, and the lymph drainage routes were observed. The investigation showed that clear computed tomography and radiographic contrast images of the thoracic duct were obtained by subcutaneous and submucosa injection of angiography contrast medium and 3D processing of these images revealed the three-dimensional positions and course of the thoracic duct and cisterna chyli.
Topics: Animals; Carbon; Contrast Media; Dogs; Drug Administration Routes; Female; Iopamidol; Lymphography; Rabbits; Thoracic Duct
PubMed: 21897061
DOI: 10.1292/jvms.11-0214 -
Journal of Anatomy Jun 2020The majority of lymph generated in the body is returned to the blood circulation via the lymphovenous junction (LVJ) of the thoracic duct (TD). A lymphovenous valve...
The majority of lymph generated in the body is returned to the blood circulation via the lymphovenous junction (LVJ) of the thoracic duct (TD). A lymphovenous valve (LVV) is thought to guard this junction by regulating the flow of lymph to the veins and preventing blood from entering the lymphatic system. Despite these important functions, the morphology and mechanism of this valve remains unclear. The aim of this study was to investigate the anatomy of the LVV of the TD. To do this, the TD and the great veins of the left side of the neck were harvested from 16 human cadavers. The LVJs from 12 cadavers were successfully identified and examined macroscopically, microscopically, and using microcomputed tomography. In many specimens, the TD branched before entering the veins. Thus, from 12 cadavers, 21 LVJs were examined. Valves were present at 71% of LVJs (15/21) and were absent in the remainder. The LVV, when present, was typically a bicuspid semilunar valve, although the relative size and position of its cusps were variable. Microscopically, the valve cusps comprised luminal extensions of endothelium with a thin core of collagenous extracellular matrix. This study clearly demonstrated the morphology of the human LVV. This valve may prevent blood from entering the lymphatic system, but its variability and frequent absence calls into question its utility. Further structural and functional studies are required to better define the role of the LVV in health and disease.
Topics: Aged; Aged, 80 and over; Cadaver; Female; Humans; Lymphatic System; Lymphatic Vessels; Male; Middle Aged; Thoracic Duct; X-Ray Microtomography
PubMed: 32103496
DOI: 10.1111/joa.13167 -
Clinical Journal of Gastroenterology Aug 2021Chylothorax after esophagectomy is a serious complication that is associated with major morbidity due to dehydration and malnutrition. Reoperation with ligation of the...
Chylothorax after esophagectomy is a serious complication that is associated with major morbidity due to dehydration and malnutrition. Reoperation with ligation of the thoracic duct is considered for patients with high-output chyle leaks that have failed conservative management. In this report, we present the treatment options for chylothorax after esophagectomy: inguinal intranodal lymphangiography and transvenous retrograde thoracic duct embolization. A 74-year-old man with esophageal cancer had been operated with thoracoscopic esophagectomy. Six days after surgery, he presented with high-output chyle leaks. Conservative treatment did not result in a significant improvement. Inguinal intranodal lymphangiography and transvenous retrograde thoracic duct embolization were performed 13 days after surgery and were technically and clinically successful. Inguinal intranodal lymphangiography and transvenous retrograde thoracic duct embolization are an effective treatment option, especially for patients after esophagectomy with reconstruction performed via the posterior mediastinal route, without the potential for damage the gastric tube and omentum.
Topics: Aged; Chylothorax; Embolization, Therapeutic; Esophagectomy; Humans; Lymphography; Male; Postoperative Complications; Thoracic Duct
PubMed: 33974188
DOI: 10.1007/s12328-021-01429-z -
Diagnostic and Interventional Radiology... Mar 2023To demonstrate intranodal thoracic duct embolization (TDE) for treating chyle leaks following thoracic surgery and the feasibility of applying lower-limb intermittent...
PURPOSE
To demonstrate intranodal thoracic duct embolization (TDE) for treating chyle leaks following thoracic surgery and the feasibility of applying lower-limb intermittent pneumatic compression devices during TDE.
METHODS
Between December 2017 and October 2020, 12 consecutive TDEs for post-operative chyle leaks were performed in 11 patients using intranodal lymphangiogram (IL) with an intermittent pneumatic compressive device applied to the lower limb. The procedure's duration, technical/clinical success, and complications were retrospectively evaluated.
RESULTS
IL was successful at imaging the thoracic duct in all procedures (100%), and TDE had an intention- to-treat success rate of 92% (11/12). No related complications were observed during follow-up, which took place at a mean of 27 days. The time from the commencement of lymphangiogram until visualization of the thoracic duct was a mean of 21.6 min, and the mean overall procedure time was 87.3 min.
CONCLUSION
This study supports IL-guided TDE as a safe and effective option to treat post-thoracic surgery chyle leaks. We revealed shorter lymphangiogram times compared with previously published studies, and we postulate that the application of intermittent lower-limb pneumatic compressive devices contributed toward this study's results by expediting the return of lymph from the lower limb. This study is the first to illustrate this approach in TDE and advocates for randomized controlled studies to further evaluate the influence of intermittent pneumatic compressive devices on the procedure.
Topics: Humans; Feasibility Studies; Chylothorax; Thoracic Duct; Retrospective Studies; Intermittent Pneumatic Compression Devices; Embolization, Therapeutic
PubMed: 36987984
DOI: 10.5152/dir.2022.21975 -
The Journal of Thoracic and... Dec 2017
Topics: Cardiac Surgical Procedures; Chylothorax; Diaphragm; Humans; Infant; Thoracic Duct
PubMed: 28987741
DOI: 10.1016/j.jtcvs.2017.08.113 -
Open Veterinary Journal Apr 2020In humans, visualization of the thoracic duct by magnetic resonance imaging (MRI) has been attempted, and recent advances have enabled clinicians to visualize the...
BACKGROUND
In humans, visualization of the thoracic duct by magnetic resonance imaging (MRI) has been attempted, and recent advances have enabled clinicians to visualize the thoracic duct configuration in a less invasive manner. Moreover, MRI does not require contrast media, and it enables visualization of morphological details of the thoracic structures. In veterinary practice, the thoracic duct has not been visualized three dimensionally in MRI.
AIM
This study aimed to assess the performance of our magnetic resonance thoracic ductography (MRTD) technique to visualize the thoracic duct and the surrounding 3D anatomical structures by combining MRTD and vascular contrast-enhanced thoracic computed tomography (CT) images in dogs.
METHODS
Five adult male beagle dogs (11.4-12.8 kg) were included in this study. Sagittal and transverse T2-weighted images were scanned in MRI. Scanning in MRTD used a single-shot fast spin echo sequence with a respiratory gate. CT was performed after the intravenous injection of contrast medium. All MRTD and CT images were merged using a workstation.
RESULTS
The thoracic ducts were identified in MRTD images of all dogs, and the surrounding anatomical structures were located with the aid of contrast-enhanced thoracic CT. In all dogs, the thoracic ducts coursed along the right-dorsal side of the aorta, cranially from the L2 level. Thereafter, these bent to the left side at the aortic arch and curved at the left external jugular vein angle. A comparison of the number of thoracic ducts at each vertebra between transverse T2WI and MRTD did not reveal any significant differences for all vertebrae.
CONCLUSION
The results from our study suggest that MRTD using the single-shot fast spin echo sequence could be a useful tool for visualization of the thoracic duct. Furthermore, the image merged from MRTD and vascular-enhanced images provided detailed anatomical annotation of the thorax. The MRTD protocol described in this study is safe and easily adaptable, without the need for contrast medium injection into the lymph system. In addition, the images fused from MRTD and vascular contrast-enhanced CT image of the thorax could provide detailed anatomical annotations for preoperative planning.
Topics: Animals; Contrast Media; Dogs; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Male; Thoracic Duct; Tomography, X-Ray Computed
PubMed: 32426259
DOI: 10.4314/ovj.v10i1.11 -
Diseases of the Esophagus : Official... Jan 2023The clinical consequences of chyle leakage following esophagectomy are underexposed. The aim of this study was to investigate the clinical implications of chyle leakage...
The clinical consequences of chyle leakage following esophagectomy are underexposed. The aim of this study was to investigate the clinical implications of chyle leakage following esophagectomy. This retrospective study of prospectively collected data included patients who underwent transthoracic esophagectomy in 2017-2020. Routinely, the thoracic duct was resected en bloc as part of the mediastinal lymphadenectomy. Chyle leakage was defined as milky drain fluid for which specific treatment was initiated and/or a triglyceride level in drain fluid of ≥1.13 mmol/L, according to the Esophagectomy Complications Consensus Group (ECCG) classification. Primary endpoints were the clinical characteristics of chyle leakage (type, severity and treatment). Secondary endpoints were the impact of chyle leakage on duration of thoracic drainage and hospital stay. Chyle leakage was present in 43/314 patients (14%), of whom 24 (56%) were classified as severity A and 19 (44%) as severity B. All patients were successfully treated with either medium chain triglyceride diet (98%) or total parental nutrition (2%). There were no re-interventions for chyle leakage during initial admission, although one patient needed additional pleural drainage during readmission. Patients with chyle leakage had 3 days longer duration of thoracic drainage (bias corrected accelerated (BCa) 95%CI:0.46-0.76) and 3 days longer hospital stay (BCa 95%CI:0.07-0.36), independently of the presence of other complications. Chyle leakage is a relatively frequent complication following esophagectomy. Postoperative chyle leakage was associated with a significant longer duration of thoracic drainage and hospital admission. Nonsurgical treatment was successful in all patients with chyle leakage.
Topics: Humans; Retrospective Studies; Esophagectomy; Chyle; Thoracic Duct; Triglycerides; Postoperative Complications; Chylothorax
PubMed: 35830862
DOI: 10.1093/dote/doac047 -
PloS One 2013HOXC9 belongs to the family of homeobox transcription factors, which are regulators of body patterning and development. HOXC9 acts as a negative regulator on blood...
HOXC9 belongs to the family of homeobox transcription factors, which are regulators of body patterning and development. HOXC9 acts as a negative regulator on blood endothelial cells but its function on lymphatic vessel development has not been studied. The hyaluronan receptor homologs stabilin 1 and stabilin 2 are expressed in endothelial cells but their role in vascular development is poorly understood. This study was aimed at investigating the function of HOXC9, stabilin 2 and stabilin 1 in lymphatic vessel development in zebrafish and in endothelial cells. Morpholino-based expression silencing of HOXC9 repressed parachordal lymphangioblast assembly and thoracic duct formation in zebrafish. HOXC9 positively regulated stabilin 2 expression in zebrafish and in HUVECs and expression silencing of stabilin 2 phenocopied the HOXC9 morphant vascular phenotype. This effect could be compensated by HOXC9 mRNA injection in stabilin 2 morphant zebrafish embryos. Stabilin 1 also regulated parachordal lymphangioblast and thoracic duct formation in zebrafish but acts independently of HOXC9. On a cellular level stabilin 1 and stabilin 2 regulated endothelial cell migration and in-gel sprouting angiogenesis in endothelial cells. HOXC9 was identified as novel transcriptional regulator of parachordal lymphangioblast assembly and thoracic duct formation in zebrafish that acts via stabilin 2. Stabilin 1, which acts independently of HOXC9, has a similar function in zebrafish and both receptors control important cellular processes in endothelial cells.
Topics: Animals; Blotting, Western; Cell Adhesion Molecules, Neuronal; DNA Primers; Endothelial Cells; Gene Expression Regulation, Developmental; Green Fluorescent Proteins; Homeodomain Proteins; Human Umbilical Vein Endothelial Cells; Humans; Lymphatic Vessels; Microscopy, Fluorescence; Receptors, Lymphocyte Homing; Reverse Transcriptase Polymerase Chain Reaction; Thoracic Duct; Transfection; Zebrafish; Zebrafish Proteins
PubMed: 23484014
DOI: 10.1371/journal.pone.0058311