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PubMed1981

Supradiaphragmatic ligation of the thoracic duct in intractable chylous fistula.

Spontaneous closure of a chylous fistula is usual, but the rare intractable fistula may lead to disastrous nutritional and immunological consequences. We report the surgical management of 5 patients with intractable fistulas with daily drainage averaging 2,060 ml. Conservative therapy failing, the 5 patients underwent 6 ligations of the thoracic duct. A limited posterolateral thoracotomy was used in 3, full right thoracotomy in 2, and left thoracotomy in 1. Ligations were carried out immediately above the diaphragm, and not at the fistula site, by a mass ligature technique encircling all tissue between the azygos vein and aorta. The ligation achieved immediate cessation of drainage in four of five initial procedures and in the fifth patient, at a second operation. High-output thoracic duct fistulas may be handled by supradiphragmatic ligation of the thoracic duct. Identification of the fistula site or the dissection of the thoracic duct itself is avoided by this technique.

Aged↗
PubMed2001

Immunocytochemical detection of tumour cells in the thoracic duct of patients with an adenocarcinoma of the oesophagus.

BACKGROUND: Compared to other hollow viscus organs, the oesophagus has a unique anatomy in which lymphatic channels are abundantly present in the mucosa and submucosa. It has been hypothesized that tumour cells can directly disseminate from these superficial layers into the thoracic duct without passing juxta-tumoral lymph nodes. We investigated whether tumour cells of an oesophageal carcinoma could be detected in the thoracic duct during operative manipulation. METHODS: In patients with an adenocarcinoma of the oesophagus and/or gastro-oesophageal junction, undergoing a transthoracic resection with two-field lymphadenectomy, lymph was collected and cells were immunostained. RESULTS: Tumour cells could be detected in the thoracic duct lymph of only 1 out of 19 patients during operative manipulation. CONCLUSION: Peroperative data from this study do not support the hypothesis that oesophageal carcinoma readily metastasizes directly into the thoracic duct.

Adenocarcinoma↗
PubMed1994

Direct lymphatic drainage from the esophagus into the thoracic duct.

The lymphatic vessels from around the esophagus which drain into the thoracic duct were identified macroscopically and histologically in 106 cadavers. Direct lymphatic drainage to the duct was macroscopically demonstrated by 84 vessels in 46 cases (43.4%). In 23 cases (19.8%), large collecting vessels arose from the thoracic esophagus and opened directly into the duct. In most of these cases (15/23) these lymphatic connections were found at the levels of the 1st-3rd or 6th-8th thoracic vertebrae. Histologic study revealed that two vessels originated from the fine lymphatic plexus in the esophageal adventita, which showed monocytic infiltration. In 11 of the 23 cases, an intercalated node was found along the thoracic duct. The results suggest that lymph drains rapidly into the systemic circulation via the thoracic duct. In view of the clinical applications in esophageal carcinoma, previous accounts of the extramural esophageal lymphatics concerned in direct drainage are discussed.

Aged↗
PubMed2005

VATS thoracic-duct division for aortic surgery-related chylous leakage.

Traumatic chylothorax is a serious morbidity due to aortic surgery. We treated this complication successfully by supradiaphragmatic thoracic-duct division in five adults (three men, two women, aged 61.5+/-19.5 years) and a 3-year-old male infant after an average interval of 4.1+/-1.8 days following initial aortic surgery: graft-replacement of subclavian or descending aortic aneurysm in the adults, and correction of aortic coarctation in the infant. A right thoracoscopic approach was used in the adults and the left thoracotomy was re-used in the infant. Individual exposure and division of the thoracic duct was accomplished using an ultrasonic coagulator. The operating time was 22+/-5.5 min for the thoracoscopy cases, and 70 min for the infant. There was no mortality and no procedure-related morbidity, and chylous leakage ceased immediately in all patients. There was no recurrence of chylothorax during a mean follow-up period of 17+/-9.7 months. Despite our limited experience, we conclude that the present supradiaphragmatic thoracic duct division technique (right thoracoscopy in adults) is safe and perfectly effective, and therefore prompt application of this method is recommendable for treatment of aortic surgery-related traumatic chylo-leakage, particularly in vulnerable elderly or infant patients.

Aortic Aneurysm↗
PubMed1986

Thoracic duct cyst: diagnosis with needle aspiration.

A case of an asymptomatic posterior mediastinal thoracic duct cyst diagnosed with fluoroscopically guided needle aspiration is reported. Previously, the diagnosis of thoracic duct cyst was established surgically and more recently was established by lymphangiography. To the authors' knowledge, diagnosis using needle aspiration has not been reported.

Biopsy, Needle↗
PubMed1990

[Incisions for an approach to the cervical segment of the thoracic duct].

After a brief review of available data in the literature on the sections for surgical approach to the cervical segment of the thoracic duct, the authors made a comparative analysis, using time-honoured objective criteria on surgery, between the universal transverse cervical section (20 operated patients) for approach to the cervical segment of the thoracic duct and the oblique cervical section which they suggest (28 operated patients) it passes along the bisector of the angle formed between the thoracic pedicle of the sternocleidomastoid muscle and the upper edge of the left clavicle. It is concluded that the oblique cervical section for approach to the cervical segment of the thoracic duct is superior, with respect to accessibility and inflicted trauma.

Adolescent↗
PubMed1976

Anatomic variation of the thoracic duct and visualization of mediastinal lymph nodes: a lymphographic study.

Of 243 thoracic ducts (TD) demonstrated during pedal lymphography, 65 (26.8%) had anatomic variations. In 58 of 65 cases with TD variants, mediastinal lymph nodes were visualized. This suggests that the radiographic appearance of mediastinal nodes is associated with TD anatomic variations. Two or more channels in the cervical portion of the thoracic duct were seen in 195 of the 243 cases. A classification of these anatomic variations is proposed.

Humans↗
PubMed1995

Ligation of the thoracic duct without thoracotomy for the treatment of postoperative chylothorax: a newly designed surgical procedure.

A newly designed surgical procedure of ligation of the thoracic duct without thoracotomy for the treatment of postoperative chylothorax is presented. A case of chylothorax following resection of carcinoma of the oesophagus was treated successfully with ligation of the thoracic duct without thoracotomy. Its advantages were very prominent consisting of maintenance of the integrity of the thorax, less traumatization, no need of a drainage tube and shorter hospitalization, much easier to expose the thoracic duct than the conventional transthoracic approach. We can find no similar report in any published literature.

Chylothorax↗
PubMed2000

[Significance of features of the projection of the cervical part of the thoracic duct onto the left sternocleidomastoid muscle for performing operations involving video support].

To work out practical recommendations for using videosupport projection of cervical part of the thoracic duct on sternoclaidomastoid muscle was determined in 158 corpses of adults. Surgical access to the thoracic duct is available using common macrosurgical equipment until the moment of visualization of major lymphatic corrector, although it is reasonable to involve videosupport at following stage with the camera of videoendosurgical kit adjusted in inferior margin of the wound. This allows to perform all the necessary actions to expose cervical part of the thoracic duct and to correct them according to video information on the monitor.

Aged↗
PubMed1993

Thoracic duct lymph flow in fetal sheep with increased venous pressure from electrically induced tachycardia.

The intent of this study was to investigate thoracic duct lymph flow, as it is related to the development of hydrops fetalis during rapid atrial pacing. We studied 6 fetal sheep at 128 +/- 6 days of gestation who had chronically placed thoracic duct catheters, aortic and superior vena cava catheters, and atrial pacing electrodes. Atrial pacing at 317 beats/min caused an elevation in central venous pressure from a baseline value of 3 Torr to 7 Torr without affecting pH, arterial blood gas tensions, aortic blood pressure, total protein concentration, or colloid osmotic pressure, although there was a small rise in hematocrit. The thoracic duct lymph flow rate at baseline was 41 +/- 6 ml/h. After atrial pacing for 6 h, the lymph flow rate as measured over at least three consecutive 10-min intervals, and presumably the transvascular fluid filtration rate, increased to 67 +/- 7 ml/h if it was collected at an outflow pressure of 3 Torr, equal to the venous pressure prior to the onset of atrial pacing. However, if the lymph was collected instead at an outflow pressure of 7 Torr, equal to the actual venous pressure measured with rapid atrial pacing, then the lymph flow rate diminished to 48 +/- 5 ml/h. This difference in lymph flow secondary to the increase in venous pressure could account for a maximum of 19 ml/h of edema that accumulates in fetal interstitium and body cavities with atrial pacing.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

[Effect of hyperoncotic volume administration on capillary protein filtration and lymph flow in the thoracic duct].

The effect of an intravenous injection (2 ml/kg) of hyperoncotic (30 g%) Dextran (MW 60000) or Albumin on lymph formation and thoracic duct lymph flow was studied in 16 dogs. As a result of the injection, plasma colloid osmotic pressure increased, plasma volume increased due to fluid reabsorption from the extravascular compartment, and thus cardiac output became enhanced. Total body lymph formation was not affected as shown by an unchanged transcapillary disappearance rate of macromolecules. Thoracic duct lymph flow, however, was increased. The concomitant augmentation of lymph protein concentration and the elevated hepatic blood flow following the injection of hyperoncotic Dextran show that the increased thoracic duct lymph flow was probably brought about by an increase in hepatic lymph flow.

Animals↗
PubMed1999

Mediastinal thoracic duct cyst.

A healthy 34-year-old man had a mediastinal cyst on the imaging study. Surgical treatment was performed. The cyst was diagnosed as a thoracic duct cyst from its anatomic location and contents. Pathologic examination found it to be consistent with thoracic duct cyst. Endothelial cells on its luminal surface were identified by an immunohistologic stain with the factor VIII-related antigen. Twenty-six cases of thoracic duct cysts have been reported. We report an additional case and review the previously reported cases. We found that the ligation of the inferior pedicle of the cyst is essential to prevent postoperative chylothorax.

Adult↗
PubMed2004

Management of chyle fistula utilizing thoracoscopic ligation of the thoracic duct.

OBJECTIVES: To document the treatment of refractory chyle leaks using thoracoscopic thoracic duct ligation and provide systematic guidelines to manage chyle leaks. METHODS: The medical records of 2 patients with chyle leaks are reviewed, followed by a review of the literature on chyle leaks and their thoracoscopic management. CONCLUSIONS: Initial treatment of chyle fistula is aimed at conservative medical management. Persistent high-output fistulas (>500 cm(3)) should be considered for neck reexploration as conservative management is likely to fail. Thoracoscopic thoracic duct ligation provides a safe and efficient means of treating chyle leaks refractory to repeated surgical and medical intervention. It should also be considered as a primary surgical intervention for patients with: (1) chyle output exceeding 500 cm(3)/day where prior intraoperative attempts at ligation have failed, (2) severe metabolic and nutritional complications, (3) coexisting chylothorax with respiratory compromise, and (4) low-output fistulas (<500 cm(3)/day) of long duration (>14 days).

Chyle↗
PubMed1977

Animal model of spontaneous neoplasia based on lymph and cells collected from thoracic duct of normal dogs and dogs with malignant lymphoma.

Peripheral blood and thoracic duct lymph from normal dogs and dogs with a leukemic malignant lymphoma were compared for total and differential leukocyte count and lymph flow rate. Except for higher numbers of circulating atypical lymphocytes, the blood leukocyte count as well as the lymph cell count and flow rate were similar in both groups. Lymph cell differential pattersn in lymphoma dogs had higher numbers of lymphoblasts and minor cell types, plasmacytes, monocytes, and reticulum cells, plus degenerating and mitotic cells. There was a five-fold increase in the lymph leukocyte count shortly after irradiation in two lymphomatous dosg. Stained preparations of this lymph showed signs of 100% cell mortality. It was concluded that the thoracic duct lymph is a practical source of normal and cancerous lymphoid cells, and that the lymph and cells collected from dogs with malignant lymphoma are excellent models for certain studies of spontaneous neoplasia.

Animals↗
PubMed1993

IFN-gamma influences the migration of thoracic duct B and T lymphocyte subsets in vivo. Random increase in disappearance from the blood and differential decrease in reappearance in the lymph.

Thoracic duct lymphocytes (TDL) continuously patrol through the body, facilitating immune responses at most sites. IFN-gamma might regulate immune responses by influencing the migration of TDL. Therefore, it was investigated in vivo whether IFN-gamma affects the migration of thoracic duct B, T, CD4+, and CD8+ lymphocytes from blood to lymph. Labeled TDL were injected i.v. into rats continuously receiving IFN-gamma via a central venous catheter. The numbers of B, T, CD4+, and CD8+ lymphocytes were determined in blood and thoracic duct lymph for 120 h. IFN-gamma increased the disappearance of TDL from the blood to a similar extent in all subsets. In contrast, the reappearance of B and T lymphocyte subsets in the lymph was decreased: B lymphocytes were affected significantly more than T lymphocytes, whereas CD4+ and CD8+ lymphocytes were affected to a similar extent. Our study suggests that differential retention within the tissue rather than preferential immigration into the tissue creates a microenvironment with a distinct composition of lymphocyte subsets.

Animals↗
PubMed1970

Rat thoracic duct lymphocytes: types that participate in inflammation.

Newly formed small lymphocytes with a short life-span in the blood are the only cells from thoracic duct lymph which accumulate in acutely inflamed tissue. This conclusion is drawn from studies in which rats with induced peritonieal exudates were injected intravenously with radioactively labeled thoracic duct cells. Radioactivity, originally vested in newly formed donor small lymphocytes, was found later in a small number of similar exudate cells. Small lymphocytes generated 10 days or more before the thoracic ducts were cannulated failed to localize in peritoneal exudates, although the cells moved in large numbers from the blood in to lymph nodes.

Animals↗