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PubMed1980

Preliminary evidence of dual-marked lymphocytes in thoracic duct lymph fluid.

Thoracic duct lymphocytes from patients receiving thoracic duct drainage as a pretransplant therapy were examined for cell surface markers. Patients followed over the drainage time period showed a variable but decreasing percentage of E-rosette-positive cells in the lymph fluid. A substantial percentage of these E-rosette-positive cells also had C3 receptors on their cell surface. Reactions of the whole lymphocytes with a heteroantisera to human B-lymphocyte antigens reflected the increasing proportion of B cells in the samples, but also indicated that a fraction of the T cells have Ia-like antigens on their surface marker characteristics. Significance of these cells with respect to graft survival is discussed.

Animals↗
PubMed1983

Thoracic duct obstruction associated with the thoracic outlet syndrome.

A case is presented in which intermittent swelling of the face, left upper limb and both lower limbs was associated with steatorrhea. The thoracic duct was found to be obstructed at the thoracic outlet. After surgery the symptoms disappeared promptly. The value of lymphography is discussed and compared to the other diagnostic methods.

Constriction, Pathologic↗
PubMed1980

Lymphocyte recognition of lymph node high endothelium. I. Inhibition of in vitro binding by a component of thoracic duct lymph.

Rat thoracic duct lymphocytes (TDL) adhere selectively to HEV when overlaid onto glutaraldehyde-fixed frozen sections of lymph node. The results presented demonstrate that thoracic duct lymph contains a factor capable of inhibiting this reaction. A crude preparation of inhibitory factor was isolated from cell and chylomicron-free lymph by (NH4)2SO4 precipitation (60 to 80% saturation). Sephacryl S-200 chromatography revealed 4 major peaks. The inhibitory factor was detected in peak I but not in the others. Similarly peak I but not peak II or III inhibited HEV binding of lymphocytes from lymph nodes and spleen. Peak I emerged near aldolase (m.w. 160,000) and was enriched approximately 50-fold compared to the crude preparation. In addition, experiments employing a rabbit peak I antiserum provided evidence that molecules responsible for inhibition were antigenically related to structures present on TDL but not on thymocytes. It is suggested that inhibitory factor possesses an affinity for lymphocyte binding sites of high endothelium and is derived from shed TDL surface components that play a role in adherence to HEV of lymph nodes.

Animals↗
PubMed2002

Traumatic injury of the thoracic duct.

Injuries to the thoracic duct are infrequent but may become life-threatening when chylous leakage persists. This report describes 6 patients with such injuries in whom the leakage resolved spontaneously in one, was corrected using microsurgical lymphatic repair or lymphatic-venous anastomosis in two, successfully treated either by ligation of the thoracic duct or insertion of a peritoneovenous shunt in two, and was eventually controlled after bilateral pleurodesis and thoracic duct ligation by insertion of a peritoneo-venous shunt in one. Conventional lymphography is superior to lymphoscintigraphy and is usually required to document disruption of the thoracic duct.

Adolescent↗
PubMed1987

Angiogenesis and the formation of lymphaticlike channels in cultures of thoracic duct.

Segments of rat thoracic duct cultured in plasma clot or in collagen gel produced microvascular and fibroblastic outgrowths. Lymphaticlike channels (LLC) with a highly attenuated endothelium, which was barely visible by light microscopy, were found in 8 out of 25 cultures (32%). Serial histologic sections revealed that the endothelium of the LLC was continuous with the intimal endothelium of the thoracic duct and was therefore of lymphatic origin. In addition to the LLC, vascular channels lined by a thick endothelium with hump-shaped, cross-sectional profiles were found in 10 cultures (40%). These channels were indistinguishable from the microvessels of blood vascular origin that formed in parallel cultures of rat aorta or periductal adipose tissue and were termed hematiclike channels (HLC). Contrary to the LLC, the HLC did not originate from the lymphatic endothelium of the thoracic duct. The frequent association of the HLC with the adventitia of the thoracic duct and with the surrounding adipose tissue suggested that they probably developed from the hematic microvessels of the periductal soft tissues.

Adipose Tissue↗
PubMed2001

Management of thoracic duct injuries after oesophagectomy.

BACKGROUND: Thoracic duct laceration is a rare but potentially life-threatening complication of oesophagectomy. The management of such an injury is uncertain in respect of the relative merits of conservative and surgical treatment. METHODS: The literature was reviewed by searching Medline databases from 1966 to the present time. The majority of the evidence presented is level 3, as no randomized or controlled data are available. RESULTS: Prolonged conservative treatment of thoracic duct injury is associated with a mortality rate of 50-82 per cent. The results of early surgical ligation of the duct are more encouraging, with a mortality rate of 10-16 per cent. Elective ligation of the duct reduces the incidence of postoperative chylothorax. CONCLUSION: The thoracic duct should be ligated during oesophagectomy. A high index of suspicion for duct injury must be maintained in all patients after operation. A policy of very early thoracic duct ligation at 48 h from diagnosis is proposed for duct injury if aggressive conservative management fails.

Animals↗
PubMed2003

Clinical feasibility of noncontrast-enhanced magnetic resonance lymphography of the thoracic duct.

STUDY OBJECTIVE: The dilatation of the thoracic duct was previously demonstrated in liver cirrhosis by lymphangiography, endoscopic ultrasound, and at autopsy. The evaluation of the morphologic change of the thoracic duct may be important in assessing the altered lymphodynamics in liver cirrhosis. The objectives of this study were to determine which combination of posture and breathing phase during noncontrast-enhanced magnetic resonance lymphography (MRL) provided the clearest images, and to evaluate the morphologic changes in the thoracic duct in healthy volunteers and patients with liver disease and malignancy. DESIGN: Prospective study. SETTING: Community general hospital. DESIGN AND SUBJECTS: Twenty-three healthy volunteers and 113 patients underwent the MRL examination using a three-dimensional, half-Fourier, fast spin echo sequence on a 1.5-T, whole-body magnetic resonance system. The appropriate posture and breathing phase of MRL to obtain the best visualization was first determined by trial on 14 healthy volunteers. Morphologic changes of the thoracic ducts were evaluated in 23 healthy volunteers including the 14 healthy volunteers for the first trial and 113 patients using this appropriate method. The width of the thoracic ducts in both patients and volunteers was measured. MEASUREMENTS AND RESULTS: MRL with respiratory gating in the supine position depicted the thoracic duct well and was the most comfortable for the subjects. In 82 of 113 patients (72.6%), the thoracic ducts were entirely visualized from the diaphragm level to the subclavian region. The remaining 31 patients had ducts that could not be entirely visualized due to sections or short lengths that were obscured. The maximum diameter was 3.74 +/- 0.81 mm in all healthy volunteers, 6.98 +/- 2.77 mm in alcoholic cirrhosis, 4.12 +/- 1.51 mm in nonalcoholic cirrhosis, 3.76 +/- 1.10 mm in malignancy, and 3.60 +/- 0.80 mm in chronic hepatitis (mean +/- SD). The diameter in alcoholic cirrhosis was significantly greater than in other groups (p < 0.01). CONCLUSIONS: Respiratory gating in the supine position is the best MRL method for acquiring the clearest images. This may be a good method of detecting morphologic changes in the thoracic duct. The patients with alcoholic cirrhosis showed a greater thoracic duct diameter than other groups.

Adult↗
PubMed1975

Surgical techniques for long-term studies of thoracic duct circulation in the rat.

Two techniques for cannulation of the thoracic duct in the rat, thoracic duct shunt and thoracic duct side fistula, are described. They give access, for repetitive sampling, to a normal thoracic duct circulation and are suited for study of the circulation under physiologic conditions. The thoracic duct shunt creates, with tubing, a shunt between the caudad and cephalad ends to the cisterna chyli. The exteriorized midportion of the shunt allows observation of the lymph. In the thoracic duct side fistula, the short arm of a T tube is placed within the cisterna and sampling is done via the long arm of the tube. Ten shunts functioned for 8-26 days and 10 side fistulas functioned for 8-30 days. Average lymph flow was 0.044 ml/min (shunts) and 0.042 ml/min (side fistulas). Average thoracic duct lymphocyte output was 1,729,000 cells/min (shunts) and 2,310,000 cells/min (side fistulas). Average blood lymphocyte count was 11,700 cells/mm3 (shunts) and 12,600 cells/mm3 (side fistulas). All parameters remained stable during the period of study. Advantages of those techniques over the Bollman end fistula are presented.

Animals↗
PubMed2003

Advantage of earlier thoracoscopic clipping of thoracic duct for post-operation chylothorax following thoracic aneurysm surgery.

We report that an earlier thoracoscopic clipping of the thoracic duct was advantageous in a case of post-operation chylothorax that occurred following thoracic aneurysm surgery. A 61-year-old man developed chylothorax on postoperative day 2 following graft replacement of the descending thoracic aorta using a left-sided thoracotomy. Since a replaced graft infection is lethal, earlier thoracoscopic clipping of the thoracic duct through the right side chest wall was indicated. The patient underwent thoracoscopic clipping on postoperative day 7 and was successfully treated. The duration of drainage was 2 days and oral intake was started on the seventh day. From our results, we recommend a thoracoscopic procedure through the opposite (right) side chest wall in the early stage of chylothorax development following thoracic aneurysm surgery.

Aortic Aneurysm, Thoracic↗
PubMed2004

Lymph sampling and lymphangiography via EUS-guided transesophageal thoracic duct puncture in a swine model.

BACKGROUND: The thoracic duct plays an important role in fluid balance, lipid absorption, and transport of immunologically active cells. The thoracic duct is difficult to access but is readily identified by EUS. The present study assessed the feasibility of EUS identification and EUS-guided puncture of the thoracic duct in a swine model. METHODS: Transesophageal EUS-guided thoracic duct puncture was attempted in 3 animals under fluoroscopy. In two animals, the thoracic duct was identified by cutdown in the neck; in the third animal, EUS-guided puncture was performed under fluoroscopy alone. In one animal, the thoracic duct was opacified by injecting contrast medium. In the second animal, thoracic duct was injected with patent blue and contrast medium. OBSERVATIONS: Thoracic duct was identified and punctured successfully in all 3 animals. In the first animal, contrast medium containing lymph was aspirated. In the second animal, lymph containing patent blue was aspirated, and, in the third animal, successful puncture was confirmed by obtaining a lymphangiogram. CONCLUSIONS: This pilot study in an animal model demonstrates that transesophageal EUS-guided puncture of the thoracic duct is feasible and that the technique can be used for lymph sampling and/or lymphangiography.

Animals↗
PubMed1966

Origin and characteristics of endogenous lipid in thoracic duct lymph in rat.

Thoracic duct lymph of rats eating a fat-free diet contained 7 mg of lipid per hr. The lipid was 70% triglyceride, and largely in the d < 1.006 lipoprotein fraction. Lipid of the d < 1.006 fraction of the lymph was many times more concentrated than that of the blood plasma at the same time. It reached the thoracic duct via lymphatics from the intestine; little entered from the liver. The fatty acid moiety composing over three-fourths of the lymph lipid mass was undoubtedly derived in part from bile lipid-possibly to the extent of roughly 50%, and in some part from other intraluminal materials. Studies with labeled palmitic acid indicated that little circulating free fatty acid was taken up by the intestinal mucosa and incorporated into lymph lipid.

Animals↗