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PubMed2006

Normal CT appearance of the distal thoracic duct.

OBJECTIVE: The aims of this study were to determine how often the distal thoracic duct can be identified on neck CT and to characterize the CT appearance of the duct. MATERIALS AND METHODS: In a review of electronic medical records from January 2001 to January 2003 we identified the cases of 500 patients who had undergone CT of the neck. Because they had confounding factors such as cancer or cervical lymphadenopathy, 199 of these patients were excluded, leaving 301 patients in the study: 131 (44%) male patients and 170 (56%) female patients. The age range was 11-92 years (average age, 46 years). Two head and neck radiologists used strict diagnostic criteria and consensus to identify the distal thoracic duct on both sides of the neck. One half of the images selected at random were flipped left to right. The purpose of randomization was to avoid interpretation bias, because the thoracic duct is known to typically course within the left side of the neck. The configuration of the distal duct was tabulated, and effects of age and sex were statistically evaluated. RESULTS: The left side of the neck was unevaluable in 26 (9%) of 301 patients because of streak artifact. In the other 275 patients, the distal thoracic duct was identified in the left side of the necks of 150 (55%) of the patients. Eleven of these patients (4%) also had a visible duct in the right side of the neck, but a right-sided duct was never identified without a left-sided counterpart. The distal thoracic duct had a tubular configuration in 70 (43%), a flared configuration in 72 (45%), and a long segmental fusiform dilation in 19 (12%) of 161 patients. Patient sex had no significant effect on the appearance of the distal thoracic duct. Older patient age had a slight positive effect on the size of the duct. CONCLUSION: Familiarity with the normal CT appearance of the distal thoracic duct can be helpful in differentiating a normal duct from pathologic lesions of the lower neck, such as lymphadenopathy.

Adolescent↗
PubMed1999

Management of chylothorax by percutaneous catheterization and embolization of the thoracic duct: prospective trial.

PURPOSE: To prospectively assess the efficacy of percutaneous transabdominal thoracic duct catheterization and embolization in the management of patients with high-output chylothoracic effusions. MATERIALS AND METHODS: Eleven consecutive patients (four women and seven men; mean age, 53 years) were referred with chylothorax secondary to esophagectomy (n = 4), lobectomy (n = 1), lung transplant (n = 1), coronary artery bypass (n = 1), aortic graft (n = 2), lymphangioleiomyomatosis (n = 1), and gunshot wound (n = 1). Two patients were brought by ambulance and referred back to their hospital on the same day. Pedal lymphography was used to opacify the cisterna chyli or major retroperitoneal lymphatic trunks. When patent, these were punctured under local anesthesia with a fine needle and the thoracic duct was catheterized over a microguide wire with use of a 3-F catheter; the duct was embolized with platinum coils. Patients were followed up for decrease in thoracic drainage output and morbidity. RESULTS: There were no retroperitoneal ducts suitable for catheterization in six patients because of previous abdominal surgery, trauma, or lymphangioleiomyomatosis; the thoracic duct was successfully catheterized in five patients, a 45% technical success rate. Thoracic duct embolization was performed in four patients, with cure of effusion in two. In the other two patients, one with lymphangioleiomyomatosis and the other with nonchylous pleural fluid, continued effusion was successfully treated by means of pleurodesis. Of two patients with previous thoracic duct ligation, one was found to have the duct incompletely tied. The authors were surprised to find that previous major abdominal surgery, chronic aortic dissection, and lymphangioleiomyomatosis could obliterate major retroperitoneal lymphatic ducts and the cisterna chyli. Percutaneous study of the thoracic duct with aqueous contrast medium was more sensitive than lymphography with iodinated oil. There was no morbidity. CONCLUSIONS: Catheterization of the thoracic duct was possible in all patients who had patent major retroperitoneal lymphatic trunks. Thoracic duct embolization was curative in patients with demonstrable duct leakage. Previous abdominal surgery, aortic dissection, and lymphangioleiomyomatosis can lead to silent occlusion of retroperitoneal lymphatic trunks. Percutaneous thoracic duct catheterization and embolization is safe and can replace surgical ligation in some patients.

Adult↗
PubMed1985

Tissue culture of human and canine thoracic duct endothelium.

Endothelial cells from the canine or human thoracic duct were harvested using 0.2% collagenase digestion and grown in Media 199 supplemented with fetal bovine serum. The canine endothelial cells grew to confluence (4.4 to 12 X 10(4) cells/cm2) in 6 to 10 d; doubling times ranged from 1.5 to 2.8 d. There was a minimum critical density for cell growth between 5000 and 10 000 cells/cm2. The canine endothelial cells have been maintained in culture for periods up to 11 mo. The human thoracic duct endothelial cells are more difficult to grow and maintain. Endothelial cells were isolated from 5 out of 35 human thoracic ducts and grew for periods of up to 2 wk before degenerating. Both human and canine endothelial cells were Factor VIII positive. It has thus been demonstrated that it is possible to grow canine and, less easily, human thoracic duct endothelium in tissue culture.

Animals↗
PubMed2003

Age-related changes of elements in human thoracic ducts and azygos veins and relationships among elements.

To elucidate compositional changes of the thoracic duct with aging, the authors investigated age-related changes of elements in the thoracic ducts in comparison with the azygos veins. The subjects consisted of 22 men and 1 woman, ranging in age from 65 to 95 yr. After ordinary dissection, the thoracic ducts and azygos veins were resected from the subjects and element contents were determined by inductively coupled plasma-atomic emission spectrometry. It was found that calcium appeared to increase in the thoracic duct with aging, but the other elements, such as phosphorus, sulfur, magnesium, iron, zinc, and sodium, did not change significantly with aging. In the azygos vein, both calcium and sulfur increased significantly with aging. Regarding the relationship among elements, extremely significant direct correlations were found among calcium, phosphorus, sulfur, and magnesium in the thoracic ducts, except for phosphorus and magnesium contents with a very significant direct correlation. In the azygos veins, significant direct correlations were found between calcium and sulfur contents and between sulfur and magnesium contents. However, no significant correlations were found among calcium, phosphorus, and magnesium in the azygos veins. These results revealed that with regard to the relationship among calcium, phosphorus, and magnesium, the thoracic duct was similar to the arteries, but not to the azygos vein.

Aged↗
PubMed1994

Tracheal compression caused by traumatic thoracic duct leak.

A man with traumatic thoracic duct injury developed a lymphocele causing upper airway obstruction. Despite drainage of the chylothorax, tracheal compression persisted due to a thoracic duct tear. Operative repair of the tear resulted in resolution of the airway obstruction.

Accidents, Traffic↗
PubMed1988

An improvement on the Bollman method of restraining and collecting thoracic duct lymph from the rat.

A method of obtaining rat thoracic duct lymphocytes is described, including a review of the surgical technique, with several modifications, and including an outline of a newly designed rat restrainer that helps to triple thoracic duct output compared to the Bollman restrainer. The new restrainer allows the rat increased mobility but protects the thoracic duct cannula. Unanesthetized 200 g rats yielded 80 ml/day thoracic duct lymph containing 4.2 x 10(4) lymphocytes/ml.

Animals↗
PubMed1983

Thoracic duct and right lymphatic duct: surgical approaches for drainage in the canine with comparison of cellular and chemical contents.

The technics of drainage of the right lymphatic duct (RD) and thoracic duct (TD) used in our laboratory have been described and illustrated. In two series of experiments the components of RD and of TD lymph were compared to blood plasma collected concurrently. RD and TD lymph, collected concurrently, were also compared in a third series. RD and TD lymph differ in a number of ways including rate of flow, enzyme activity, cell count and lipid-electrophoretic patterns. The limitations of RD lymph for the study of fluid and protein dynamics of the lungs and the cell population of lung lymph are outlined. Higher levels of enzyme activity in RD compared to TD lymph have been noted. This phenomena appears to depend on a number of complex factors.

Animals↗
PubMed1987

Visualization of the thoracic duct by lymphoscintigraphy.

Imaging of the thoracic duct is usually performed by radiological lymphography. However, this procedure, which uses an oil based dye injected directly into the lymph channels, has some adverse effects. In this paper we note that lymphoscintigraphy, a physiological and non invasive method, may visualize thoracic duct abnormalities, and might be particularly useful when radiological lymphography is contraindicated.

Chylothorax↗
PubMed2004

[Examination of the thoracic duct using fast advanced spin echo].

Recent reports have indicated that depiction of the thoracic duct is possible without administration of a contrast agent using fast advanced spin echo (FASE), ECG-triggered, half-Fourier fast spin echo (FSE), by depicting blood vessels. In this study, we attempted to depict the thoracic duct using FASE, which is generally used for MR-hydrography. By varying effective echo time (effective TE), the contrast-to-noise ratios (CNR) for saline and baby oil were measured with and without fat suppression. Without fat suppression, the effective TE of 500 msec yielded the highest CNR. With fat suppression, the effective TE of 250 msec provided the highest CNR. Next, examinations of the thoracic duct were performed in volunteers in order to obtain the highest CNR. Results indicated that the best depiction of the thoracic duct was obtained using the effective TE of 500 msec in 3D-FASE without fat suppression. Thoracic duct imaging using heavily T(2)-weighted parameters allows better control of signal intensities of background and surrounding tissues than can be obtained with fat suppression. Furthermore, the heavily T(2)-weighted parameter only depicts the long T(2) components of the thoracic duct.

Echo-Planar Imaging↗
PubMed2002

Spontaneous thoracic duct cyst.

Spontaneous and asymptomatic supraclavicular thoracic duct cysts (lymphoceles ) are rare. Only five cases have been reported so far. They are more common after surgery or trauma and have been reported in the abdomen, mediastinum, pelvis and neck. They must be differentiated from other neck cysts as failure to recognise their attachment may result in the disastrous consequence of chylothorax. A high index of suspicion is necessary, and diagnosis usually can be established by fine-needle aspiration and suitable imaging. This case is reported along with a review of the literature and management options, including that of inadvertent damage to the thoracic duct.

Aged↗
PubMed1978

Effect of acute ethanol administration on the thoracic duct lymph flow in man.

In 17 patients the thoracic duct was cannulated and the lymph continuously collected. Thoracic duct lymph flow and the concentration of total protein in the lymph and blood serum were repeatedly measured for 6 hours. Group I (9 subjects) received 0.7 g/kg of oral ethanol in the form of 40% solution, group II (8 subjects) an intravenous infusion of 0.75 g/kg of ethanol. Oral but not intravenous administration of ethanol significantly increased the thoracic duct lymph flow. Lymph total protein significantly decreased in group I only.

Administration, Oral↗
PubMed1979

Diuretics, hepatic and thoracic duct lymph flows in the dog.

1. Simultaneous thoracic duct and hepatic lymph flows were measured in 29 mongrel dogs before and after the intravenous administration of mannitol, ethacrynic acid, frusemide and chlorothiazide in separate experiments. 2. Thoracic duct lymph flow increased significantly after each diuretic agent was administered. 3. Hepatic lymph flow increased only after ethacrynic acid and mannitol administration. Frusemide and chlorothiazide did not alter hepatic lymph flow. 4. These data show that increases in thoracic duct lymph flow after ethacrynic acid and mannitol arise partly from the liver, as well as from other organs.

Animals↗
PubMed1991

In vitro effects of a thromboxane A2-analogue U-46619 and noradrenaline on contractions of the human thoracic duct.

A piece of a human thoracic duct removed at operation was investigated in organ baths. The duct was cut in 8 ring segments each about 1mm long and isometric tension recorded. The segments were exposed to a potassium rich (124mM) Krebs buffer solution. In only two of the segments were contractions induced (7.2 and 1.0mN, respectively). Noradrenaline and the thromboxane mimetic U-46619 induced tonic and phasic contractions. At a noradrenaline concentration of 10(-5)M the phasic contractions had a frequency of 5 min-1. The highest frequency, 9 min-1, was recorded with 3 x 10(-10)M of U-46619 present in the bath. Noradrenaline had a mean Emax of 50% of the previous K+ (124mM)-induced contraction, and the mean pEC50-value was 6.7. The Emax and pEC50-values of U-46619 were 142% and 9.5, respectively. Postjunctional alpha-adrenoceptors and thromboxane A2-receptors may play a role in the contractility of the human thoracic duct.

15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗
PubMed1991

Improved on-line thoracic duct drainage for lymphocytapheresis.

Lymphocytapheresis using thoracic duct drainage (TDD) is a recognized technique of extracorporeal immunomodulation for various autoimmune diseases such as rheumatoid arthritis (RA), and its clinical benefit has been reported and generally accepted. Lymphocytapheresis using TDD is very selective for removing lymphocytes (especially helper T-cells) but raises some problems such as hypoproteinemia due to the massive removal of lymph, and difficulties in repeated treatment. Along with the development of a new polyester fiber filter, we have developed a simple and effective method of lymphocytapheresis for wide adoption for these techniques. We performed lymphocytapheresis using TDD in patients with RA and previously reported its clinical efficacy indicated by the significantly lower number of peripheral lymphocytes and T4/T8 ratio. We present here our newly-developed on-line system designed to prevent hypoproteinemia. Furthermore we report on the advantages with a new subcutaneous vascular access device set up to manage the problems of repeated treatments. A small reservoir for keeping the thoracic duct open and returning lymph to the patient permitted sufficient lymph drainage and removal of lymphocytes and the clinical application of TDD is discussed.

Arthritis, Rheumatoid↗
PubMed1978

Thoracic duct drainage and antilymphocyte globulin for renal transplantation in man.

Thoracic duct drainage resulting in a lymphocyte depletion of more than 20 x 10(9) cells was performed during the three months prior to transplantation in 37 patients. Results obtained in this group of patients were compared to those in transplant recipients similarly treated, over the same period, but not subjected to thoracic duct drainage. Both groups received comparable doses of antilymphocyte globulins, azathioprine and corticosteroids. No clear-cut difference in transplantation outcome was found when recipients of kidneys from related living donors (whether HLA identical or HLA haploidentical) were considered. By contrast, an improved transplant survival and a decreased incidence of rejection crises were observed in recipients of kidneys from cadaver donors when a thoracic duct drainage was performed prior to transplantation. The immunosuppressive effect of thoracic duct drainage, probably enhanced by antilymphocyte globulin treatment, is therefore a valuable adjunct to more conventional methods of pretreating human cadaveric transplant recipients.

Antilymphocyte Serum↗
PubMed1988

[Roentgenologic investigation of collateral lymphatic pathways after ligation of the thoracic duct].

In 80 Wistar rats by means of electroroentgenolymphography lymphatic pathways and thoracic duct have been studied, normal and after ligation of the latter in 1-3 days, 1 and 2-3 months. Contrasting of the thoracic duct in the control animals reveals its additional ducts, that run in parallel to the main collector and they get into it after a certain distance, as well as different time phases of filling the duct are noted. When the thoracic duct is ligated, in 1-3 days dilatation of the ductal cistern, contrasting of lymphatic vessels and nodes in other regions are observed. In 1 month of the experiment the thoracic duct cistern is poorly expressed in comparison with the early time. The contrast substance continues to get into the group of the lymph nodes in other regions. A network of anastomoses of lymphatic vessels is formed in the area of ligation. In 2-3 months, when the contrast substance continues to get retrogradely into other groups and regions of the lymph nodes, final restoration of the lymph-flow takes place at the expense of formation of collateral pathways.

Animals↗
PubMedDate not supplied

Evaluation of thoracic duct healing after experimental laceration and transection.

Healing of the thoracic duct (TD) was evaluated clinically and histologically in six healthy dogs. A 2.5 cm longitudinal laceration of the caudal TD was created in three dogs and the caudal TD was completely transected in three other dogs. The site of the defect was identified by placing one 4-0 stainless steel suture in the tissue adjacent to the TD defect. All dogs developed a chylous effusion confirmed by biochemical analysis. By five days after surgery in dogs with TD lacerations, and by 10 days after surgery in dogs with TD transections, thoracic effusion had ceased. Lymphangiography, performed seven days after resolution of thoracic effusion, showed TD patency only in the dogs with TD lacerations. The TD did not appear to be patent in dogs with TD transections. Histologically, in dogs with TD lacerations, one moderately dilated lymphatic vessel was seen at the surgical site in one animal and the thoracic duct and other lymphatics in the two other dogs appeared normal. Minimal perivascular accumulations of neutrophils, macrophages, and lymphocytes were present adjacent to two lymphatics in one animal. A mild increase in fibrous connective tissue and neovascularization was present in the adjacent subpleura. In dogs with complete transections, three to six dilated lymphatics were present at the transection site. Mild thickening of the tunica media was present in one thoracic duct, associated with a "J"-shaped area of condensed collagen, presumed to be a collapsed thoracic duct in one animal. Mild to moderate accumulations of macrophages, lymphocytes, and moderate neovascularization was present in the surrounding tissue, separating it from the underlying connective tissue.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1996

[The valvular apparatus and tissue organization of the endothelium of the thoracic duct].

The structure of ostial valves and valves located along the thoracic duct and of its branches ostial valves and right lymphatic duct ostial valves were studied in 30 experimental outbred dogs and 46 cats. Cryodestruction of thoracic duct was performed in 28 outbred cats. 1, 3, 7 and 14 days later perfusive fixation with intercellular borders impregnation was carried out with simultaneous examination of intact regions of intravalvular segments, cisterna chyli and area of thoracic duct trunks connection with valvular surfaces. Tissue organization in ageing was studied using the intervalvular segment of old animals. Specimens were studied by means of scanning electron microscopy and film preparations of endothelium. Valves, located along the thoracic duct length are bicuspid formations, while ostial ones are falciform and cuneiform respectively in 80 and 20%. Endotheliocytes of cuspids are characterized with high content of microfilaments bundles in the cytoplasm and low content of microvesicles. Cells of the valvular free margin cross the cuspid edge and have adaptive changes preventing their desquamation: fusiform shape, long basal processes and bundles of microfilaments in the cytoplasm. Peculiar "pericyte-like" cells alike with myofibroblasts lie deep in the cuspid thickness close to the sinusal venous side. Fascicles of the duct smooth myocytes reach the base of the valve. Besides, in the ostial valve stroma there is elastic membrane, better displayed along the cuspid venous side. Increased polymorphism and changes of the endotheliocytes metric characteristics were demonstrated in the zones of turbulent lymph flow. Analysis of the newly formed endothelium tissue mosaics allows to reveal mechanisms of monolayer repair: spreading and migration of endotheliocytes on the first day, their proliferation within three days, desquamation of newly formed endotheliocytes and spreading of adjacent cells on later stages.

Aging↗