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Journal of Thoracic Imaging Jul 2019Injury to the thoracic duct with resultant chylothorax can cause significant patient morbidity and mortality. Conservative treatment strategies often fail to address the... (Review)
Review
Injury to the thoracic duct with resultant chylothorax can cause significant patient morbidity and mortality. Conservative treatment strategies often fail to address the problem. Open surgical and percutaneous approaches are often required to manage patients with refractory chylothorax. This review describes in detail the major role of minimally invasive interventional therapies for thoracic duct (TD) injury. The review emphasizes strategies for identifying the TD on preprocedural imaging and describes various techniques for percutaneous access to the TD. The advantages and disadvantages of several approaches for accessing the duct are discussed. The technique of duct embolization is highlighted. The role of the minimally invasive percutaneous approach over open surgical approaches is discussed with a review of clinical outcomes, as reported in the literature. This review will also briefly discuss the surgical approach to TD ligation.
Topics: Chylothorax; Embolization, Therapeutic; Humans; Thoracic Duct; Tomography, X-Ray Computed
PubMed: 31206455
DOI: 10.1097/RTI.0000000000000422 -
European Radiology Aug 2016The thoracic duct is the body's largest lymphatic conduit, draining upwards of 75 % of lymphatic fluid and extending from the cisterna chyli to the left jugulovenous... (Review)
Review
UNLABELLED
The thoracic duct is the body's largest lymphatic conduit, draining upwards of 75 % of lymphatic fluid and extending from the cisterna chyli to the left jugulovenous angle. While a typical course has been described, it is estimated that it is present in only 40-60% of patients, often complicating already challenging interventional procedures. The lengthy course predisposes the thoracic duct to injury from a variety of iatrogenic disruptions, as well as spontaneous benign and malignant lymphatic obstructions and idiopathic causes. Disruption of the thoracic duct frequently results in chylothoraces, which subsequently cause an immunocompromised state, contribute to nutritional depletion, and impair respiratory function. Although conservative dietary treatments exist, the majority of thoracic duct disruptions require embolization in the interventional suite. This article provides a comprehensive review of the clinical importance of the thoracic duct, relevant anatomic variants, imaging, and embolization techniques for both diagnostic and interventional radiologists as well as for the general medical practitioner.
KEY POINTS
• Describe clinical importance, embryologic origin, and typical course of the thoracic duct. • Depict common/lesser-known thoracic duct anatomic variants and discuss their clinical significance. • Outline the common causes of thoracic duct injury and indications for embolization. • Review the thoracic duct embolization procedure including both pedal and intranodal approaches. • Present and illustrate the success rates and complications associated with the procedure.
Topics: Anatomic Variation; Drainage; Embolization, Therapeutic; Humans; Lymphatic Diseases; Lymphography; Thoracic Duct; Thoracic Injuries
PubMed: 26628065
DOI: 10.1007/s00330-015-4112-6 -
The Annals of Thoracic Surgery May 2020
Topics: Cadaver; Chylothorax; Humans; Ligation; Lymphography; Thoracic Duct; Thoracoscopy; Tomography, X-Ray Computed
PubMed: 32035916
DOI: 10.1016/j.athoracsur.2020.01.004 -
Asian Journal of Surgery Jul 2023
Topics: Humans; Thoracic Duct; Dilatation; Dilatation, Pathologic
PubMed: 37173246
DOI: 10.1016/j.asjsur.2023.03.194 -
Lymphology 2020[Editorial] Thoracic duct decompression (TDD) is an idea first proposed and applied as a novel therapeutic strategy by lymphologists in the 1960's. TDD is recently being...
[Editorial] Thoracic duct decompression (TDD) is an idea first proposed and applied as a novel therapeutic strategy by lymphologists in the 1960's. TDD is recently being reexamined and, in selected patients with portal hypertension from hepatic cirrhosis or with central venous hypertension from isolated right-sided heart failure, undertaken using advanced surgical and image-guided interventional radiologic approaches.
Topics: Decompression; Humans; Hypertension, Portal; Liver Cirrhosis; Stents; Thoracic Duct
PubMed: 33190427
DOI: No ID Found -
The International Journal of Medical... Jun 2022Indocyanine green (ICG) lymphography can be performed to obtain realtime fluorescent images of the thoracic duct (TD). The injection of ICG into the inguinal nodes... (Review)
Review
INTRODUCTION
Indocyanine green (ICG) lymphography can be performed to obtain realtime fluorescent images of the thoracic duct (TD). The injection of ICG into the inguinal nodes usually is ultrasound-guided. Our hypothesis was to simplify the ICG administration until making it executable by unqualified personnel without ultrasound guidance.
MATERIAL AND METHODS
From October 2019 to October 2021 we enroled 18 patients. ICG was injected with a 25 Gauge needle in the subcutaneous tissue of the inguinal region bilaterally 14-16 h before surgery.
RESULTS
The TD was visualised in every case considered. The easy switching between fluorescence and white light visualization facilitated the identification and dissection of the TD avoiding involuntary injuries.
CONCLUSIONS
The simplified ICG administration to identify TD during oesophagectomy is easy to perform, does not require specifically trained staff, is not time demanding and has comparable results to the procedure performed under ultrasound guide.
Topics: Coloring Agents; Humans; Indocyanine Green; Lymph Nodes; Lymphography; Thoracic Duct
PubMed: 35120398
DOI: 10.1002/rcs.2380 -
Clinical Imaging 2017Disruption of the thoracic duct can have devastating consequences and be associated with a high morbidity and mortality. Conservative therapies have been attempted to... (Review)
Review
Disruption of the thoracic duct can have devastating consequences and be associated with a high morbidity and mortality. Conservative therapies have been attempted to treat chylothorax without much success. Surgical management has traditionally been necessary to provide definitive treatment at the expense of increased morbidity. Lymphatic interventions have recently emerged as a new frontier for interventional radiologists to add value and provide minimally invasive therapies for debilitating conditions. The goal of this manuscript is to review the anatomy of the thoracic duct, describe various percutaneous techniques for accessing the duct, and briefly discuss outcomes as reported in the literature.
Topics: Chylothorax; Embolization, Therapeutic; Humans; Lymphography; Radiology, Interventional; Thoracic Duct; Thoracic Injuries
PubMed: 28103513
DOI: 10.1016/j.clinimag.2016.12.012 -
Otolaryngology--head and Neck Surgery :... Feb 2005Cysts of the thoracic duct located in the supraclavicular region are uncommon. To date only 12 cases in this topographic area have been described in the literature.... (Review)
Review
OBJECTIVE
Cysts of the thoracic duct located in the supraclavicular region are uncommon. To date only 12 cases in this topographic area have been described in the literature. Between 1998 and 2002, 5 patients presented to our department with the primary symptom of a palpable soft left-supracavicular swelling that could be displaced relative to adjacent structures.
SETTING
In each case, sonography showed a hypoechogenic, almost echo-free, distinctly outlined polycyclic structure with distal echo enhancement at the junction of the left internal jugular vein and the subclavian vein. All 5 patients underwent surgery, the cysts were extirpated, and the numerous communicating lymph vessels localized and meticulously ligated. Pathohistologic analysis of the milky, yellowish fluid obtained by intraoperative puncture confirmed the initial suspicion of a thoracic duct cyst in all patients.
CONCLUSION
In the case of left supraclavicular masses, the rare differential diagnosis of a thoracic duct cyst must be considered as a possibility. Sonography as the imaging method of choice is sufficient for primary diagnosis. In addition, a thorax x-ray should be performed in order to exclude an intrathoracic involvement. Surgical extirpation marks the therapy of choice in treating such cysts.
Topics: Adult; Aged; Clavicle; Diagnosis, Differential; Female; Humans; Male; Mediastinal Cyst; Middle Aged; Thoracic Duct; Treatment Outcome; Ultrasonography
PubMed: 15692550
DOI: 10.1016/j.otohns.2004.09.002 -
Catheterization and Cardiovascular... May 2023
Topics: Humans; Thoracic Duct; Treatment Outcome; Chylothorax
PubMed: 37070478
DOI: 10.1002/ccd.30660 -
Cirugia Y Cirujanos Dec 2017Cervical thoracic duct cysts are a rare anomaly. (Review)
Review
BACKGROUND
Cervical thoracic duct cysts are a rare anomaly.
OBJECTIVE
To report a case of cervical thoracic duct cyst, and perform a literature review.
CLINICAL CASE
A 78-year-old female, with a one-year history of a left-sided asymptomatic supraclavicular cystic mass. Computerized tomography revealed a cystic mass 42mm in diameter. We performed a fine needle aspiration puncture, obtaining a thick, milky, whitish liquid. The patient underwent surgery; finding a left-sided supraclavicular cystic mass, with some lymph vessels heading towards the jugulo subclavian venous junction. We performed a ligation of these lymph vessels and resection of the mass. The histopathologic study confirmed the diagnosis of thoracic duct cyst.
CONCLUSION
Diagnosis of cervical thoracic duct cyst should be suspected with a cystic lesion in the left supraclavicular region, which when perforated exudes a very distinctive thick milky, whitish liquid with a high content of lymphocytes and triglycerides. Treatment should be complete removal with ligation of the lymphatic afferent vessels.
Topics: Aged; Biopsy, Fine-Needle; Female; Humans; Ligation; Lymphatic Vessels; Mediastinal Cyst; Thoracic Duct; Tomography, X-Ray Computed
PubMed: 28040230
DOI: 10.1016/j.circir.2016.11.010