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PubMed1995

Isolated thoracic duct injury after penetrating chest trauma.

BACKGROUND: Isolated thoracic duct injuries as a result of penetrating chest trauma without any major vascular or tracheoesophageal injury seldom are seen. METHODS: A retrospective 13-year review identified 8 patients with this injury. RESULTS: Seven had supraclavicular or suprascapular knife stabs, and the eighth had a low-velocity gunshot injury entering the mid-lateral right chest wall. All 7 stab victims presented with left-sided chylothoraces, and the site of injury of the thoracic duct was within Poirier's triangle, the borders of which are the arch of aorta, the left subclavian artery, and the vertebral column as seen from a lateral approach. Five patients initially were treated conservatively for 13.4 +/- 4.4 days without success. Surgical intervention thus was necessary and was successful in all 8 patients. The thoracic duct injury was controlled successfully through a left posterolateral thoracotomy in 6 patients. A supraclavicular repair was attempted in 1 patient but failed to control the leak and required reexploration via the supraclavicular approach. The right chylothorax from the gunshot injury was explored via a right posterolateral thoracotomy; the leak into the pleura was identified and obliterated. CONCLUSIONS: As conservative management was uniformly unsuccessful, we advocate early operative management through a thoracotomy on the side of the chylothorax for this relatively rare injury.

Adult↗
PubMed1997

Lymph flow pattern in the intact thoracic duct in sheep.

1. To study the lymph flow dynamics in the intact thoracic duct, we applied an ultrasound transit-time flow probe in seven anaesthetized and four unanaesthetized adult sheep (approximately 60 kg). In unanaesthetized non-fasting animals we found that lymph flow in the thoracic duct was always regular pulsatile (pulsation frequency, 5.2 +/- 0.8 min-1) with no relation to heart or respiratory activity. At baseline the peak level of the thoracic duct pulse flow was 11.6-20.7 ml min-1 with a nadir of 0-3.6 ml min-1. Mean lymph flow was 5.4 +/- 3.1 ml min-1. The flow pattern of lymph in the thoracic duct was essentially the same in the anaesthetized animals. 2. In both the anaesthetized and unanaesthetized animals, the lymph flow response to a stepwise increase in the outflow venous pressure showed interindividual variation. Some were sensitive to any increase in outflow venous pressure, but others were resistant in that lymph flow did not decrease until outflow venous pressure was increased to higher levels. This resistance was also observed in the high lymph flow condition produced by fluid infusion in the anaesthetized animal and mechanical constriction of the caudal vena cava in the unaesthetized animals. Pulsation frequency of the thoracic duct flow initially increased and then decreased with a stepwise increase in the outflow venous pressure. This initial increase might be a compensatory response to maintain lymph flow against elevated outflow venous pressure. 3. To test the effect of long-term outflow venous pressure elevation in unanaesthetized sheep, outflow venous pressure was increased by inflation of a cuff around the cranial vena cava for 1, 5 or 25 h. The cuff was inflated to a level where lymph flow was reduced. Lymph flow remained low or decreased further during the entire cuff-inflation period. We calculated the lymph debt caused by the outflow venous pressure elevation and the amount 'repaid' when venous pressure returned to normal. Lymph debt for 25 h was 6400 ml but only 200 ml was repaid. Since we observed no visible oedema formation in the lower body of the sheep, the non-colloidal components of the lymph must have been reabsorbed into the bloodstream, most likely in the lymph nodes.

Activity Cycles↗
PubMed1968

Cell to cell interaction in the immune response. II. The source of hemolysin-forming cells in irradiated mice given bone marrow and thymus or thoracic duct lymphocytes.

The number of discrete hemolytic foci and of hemolysin-forming cells arising in the spleens of heavily irradiated mice given sheep erythrocytes and either syngeneic thymus or bone marrow was not significantly greater than that detected in controls given antigen alone. Thoracic duct cells injected with sheep erythrocytes significantly increased the number of hemolytic foci and 10 million cells gave rise to over 1000 hemolysin-forming cells per spleen. A synergistic effect was observed when syngeneic thoracic duct cells were mixed with syngeneic marrow cells: the number of hemolysin-forming cells produced in this case was far greater than could be accounted for by summating the activities of either cell population given alone. The number of hemolytic foci produced by the mixed population was not however greater than that produced by an equivalent number of thoracic duct cells given without bone marrow. Thymus cells given together with syngeneic bone marrow enabled irradiated mice to produce hemolysin-forming cells but were much less effective than the same number of thoracic duct cells. Likewise syngeneic thymus cells were not as effective as thoracic duct cells in enabling thymectomized irradiated bone marrow-protected hosts to produce hemolysin-forming cells in response to sheep erythrocytes. Irradiated recipients of semiallogeneic thoracic duct cells produced hemolysin-forming cells of donor-type as shown by the use of anti-H2 sera. The identity of the hemolysin-forming cells in the spleens of irradiated mice receiving a mixed inoculum of semiallogeneic thoracic duct cells and syngeneic marrow was not determined because no synergistic effect was obtained in these recipients in contrast to the results in the syngeneic situation. Thymectomized irradiated mice protected with bone marrow for a period of 2 wk and injected with semiallogeneic thoracic duct cells together with sheep erythrocytes did however produce a far greater number of hemolysin-forming cells than irradiated mice receiving the same number of thoracic duct cells without bone marrow. Anti-H2 sera revealed that the antibody-forming cells arising in the spleens of these thymectomized irradiated hosts were derived, not from the injected thoracic duct cells, but from bone marrow. It is concluded that thoracic duct lymph contains a mixture of cell types: some are hemolysin-forming cell precursors and others are antigen-reactive cells which can interact with antigen and initiate the differentiation of hemolysin-forming cell precursors to antibody-forming cells. Bone marrow contains only precursors of hemolysin-forming cells and thymus contains only antigen-reactive cells but in a proportion that is far less than in thoracic duct lymph.

Animals↗
PubMed2003

One technique, two approaches, and results: thoracic duct cannulation in small laboratory animals.

Experimental studies in immunology, pharmacology, or hematology require the sampling of the total thoracic duct lymph in awake and unrestrained rats or mice. Several approaches have been described for cannulation of the thoracic duct, but they are characterized by a modest reproducibility and a low lymph flow rate. An improved technique for obtaining thoracic duct lymph is described here, emphasizing the similarities and differences concerning both rats and mice (average weights of 305 and 15 g, respectively). Rats yielded a mean of 55.6 ml/day thoracic duct lymph, while lymph output in mice reached unexpected volumes of 29.3 ml/day. The use of an operating microscope and silicone cannula, and maintenance of mobility of the animals during lymph collection, offer a reliable method for a high and constant output of thoracic duct lymph. Relevant aspects of the murine thoracic duct anatomy are also identified.

Animals↗
PubMed1999

Thoracic duct cyst: a case report and review of 29 cases.

Cysts of the thoracic duct are rare. We report a case of a cervical thoracic duct cyst and review 29 thoracic duct cysts reported previously (19 mediastinal, 9 cervical, and 1 abdominal). The mean age of the patients was 47.6 years (range 17 to 86 years). Fourteen (46.7%) of the patients were asymptomatic. When symptoms were present, they ranged from retrosternal pain, dysphagia, and dyspnea to respiratory insufficiency and superior vena cava compression. Diagnosis of the cyst can be made after computed tomography or ultrasonography. The cystic fluid contains T lymphocytes and triglycerides in excess. The symptoms in a patient with a thoracic duct cyst are related to compression of adjacent structures. The most profound symptoms are likely to be produced by mediastinal cysts above the aortic arch. Treatment consists of surgical removal of the cyst and ligation of all lymphatics connected to the cyst.

Adolescent↗
PubMed1992

Increased venous pressure causes increased thoracic duct pressure in awake sheep.

The lymph from most organs drains through the thoracic duct and into veins in the neck. We hypothesized that increases in neck vein pressure (Pnv) are reflected through the thoracic duct to the lung lymphatic-thoracic duct junction. To test this, we cannulated the lung lymphatics in the direction of flow in four sheep. We advanced each cannula until it entered the thoracic duct. Thus the pressure at the tip of the lymphatic cannula (Px) was the pressure at the outflow of the lung lymphatics. We also placed a balloon into the superior vena cava. One to two days later, we measured Px in the awake sheep as we inflated the balloon and increased Pnv in steps to 25-45 cmH2O. We found no significant differences in Px and Pnv. Furthermore, Px closely followed Pnv after each step increase in Pnv. These results support our hypothesis that increases in Pnv cause increases in the outflow pressure to lung lymphatics.

Animals↗
PubMed1988

Combined monitoring of thoracic duct and lung lymph during E. coli sepsis in awake sheep.

A thoracic duct lymph fistula in combination with a lung lymph fistula in the awake sheep was used to evaluate effects of thoracic lymph diversion during a septic insult and to monitor systemic and local changes in the lung and gastrointestinal tract. Live Escherichia coli 10(9) kg-1 b.w. were infused in 9 sheep. After sepsis, arterial pressure, cardiac output, partial pressure of oxygen, leukocytes and platelets decreased significantly compared to baseline values. Pulmonary arterial pressure increased significantly throughout the experiment with peak values at 44 +/- 4 mmHg after 15 minutes. Lung lymph flow (QL) (n = 6) increased from 23 +/- 0.5 to 11.2 +/- 2.4 ml/30 minutes after 60 minutes. QL then decreased but remained elevated. Lymph to plasma protein concentration ratio (L/P) in lung lymph decreased from 0.62 +/- 0.02 during baseline to 0.47 +/- 0.04 after 60 minutes. L/P then increased and was, after 150 minutes, no longer different from baseline. These lung lymph data favor increased pulmonary microvascular permeability during sepsis. Lymph flow in the thoracic duct (QT) (n = 9) increased from 34.2 +/- 6 to 58.3 +/- 9 ml/30 minutes during the first 30 minutes after bacterial infusion. QT was, after 90 minutes, back to baseline but then progressively increased. L/P in thoracic lymph steadily increased from 0.56 +/- 0.03 to 0.78 +/- 0.04. Thromboxane B2 and 6-keto PGF1 alpha in thoracic duct and lung lymph increased significantly after bacterial infusion and remained elevated thereafter. Combined monitoring of thoracic duct and lung lymph enabled comparison of systemic and pulmonary reactions in septic sheep.

Animals↗
PubMed2006

[Evaluating prophylactic ligation of thoracic duct during radical resection of esophageal carcinoma].

BACKGROUND & OBJECTIVE: Prophylactic ligation of thoracic duct during the radical resection of esophageal carcinoma is usually used to prevent and treat chylothorax, but there is dispute about the effect. Its correlation to other complications and prognosis of esophageal carcinoma patients after operation has seldom been reported. The study was to evaluate its preventive effect on chylothorax and its influences on other complications and prognosis of esophageal carcinoma patients. METHODS: Clinical data from 389 patients who underwent radical transthoracic esophagectomy from Jun. 1991 to Jun. 1996 in Cancer Center of Sun Yat-sen University were retrospectively analyzed. Of the 389 patients, 171 received thoracic duct ligation (ligation group), and 218 had thoracic duct preserved (preservation group). The occurrence rates of chylothorax and other complications, and the survival rates were compared between the 2 groups. RESULTS: The occurrence rates of chylothorax were 1.17% in ligation group and 0.46% in preservation group (P<0.001). The occurrence rates of complication were 18.2% in ligation group and 11.5% in preservation group (P=0.063). Perioperative mortalities were 1.75% in ligation group and 0.92% in preservation group (P=0.658). The 1-, 2-, 3-, and 5-year survival rates were 74.3%, 52.1%, 42.1%, and 29.2% in ligation group, and 74.3%, 53.2%, 43.1%, and 29.8% in preservation group (P=0.992, 0.819, 0.841, 0.902). CONCLUSION: Prophylactic ligation of thoracic duct during esophagectomy for patients with esophageal carcinoma could not prevent chylothorax effectively, and has no obvious influence on the occurrence of other complications and survival of the patients after operation.

Chylothorax↗
PubMed2007

Thoracic duct cyst: sclerotherapy as alternative for surgical treatment.

BACKGROUND: Thoracic duct cysts of the cervical portion are rare benign lesions for which surgery is the treatment of choice. METHODS: We present 2 cases of a thoracic duct cyst of the cervical portion. One patient was treated by surgery and the other patient by ethanol sclerotherapy. RESULTS: After establishing diagnosis by radiologic assessment and chemical and cytological fine-needle aspirate of the cystic masses, both patients were treated successfully. CONCLUSION: Ethanol sclerotherapy provides an alternative therapy for thoracic duct cyst when evaluation establishes a high likelihood of clinical diagnosis.

Aged↗
PubMed1988

Ultrastructural morphology of the canine thoracic duct and cisterna chyli.

The ultrastructural morphology of the thoracic duct and cisterna chyli of the dog was examined using scanning and transmission electron microscopy. Examination of the cisterna chyli, reservoir of the lymphatic system, featured a number of afferent lymphatics draining into the cisterna: valves were however absent. The luminal surface of the endothelial lining of both the thoracic duct and cisterna demonstrated ovoid endothelial nuclei with numerous cellular ridges. Considerable variation existed in the number of smooth muscle cells lining the duct and cisterna in the contracted and distended state. Organelles and inclusions characteristic of endothelium and smooth muscle were identified. Reflux of lymph into the thoracic duct was prevented by a mono- and bicuspid valve situated at the lymphaticovenous junction.

Animals↗
PubMed1985

Effect of increased systemic venous pressure on thoracic duct and peripheral lymph flow in dogs.

In congestive heart failure, lymph flow from the cannulated thoracic duct is greatly increased. However, there has been scant data on lymph flow in the intact lymphatic system with systemic circulatory congestion. In the present study, thoracic duct and peripheral lymph flow were qualitatively determined using heated cross-thermocouples in seven mongrel dogs. Central venous pressure was raised artificially by infusing large volumes of crystalloid solution equivalent to a maximum of 30% of body weight. Although both thoracic duct and peripheral lymph flow increased with an intact (closed) lymphatic system, the increase was notably less than with a transected (opened) cervical thoracic duct. With systemic circulatory congestion, cannulated thoracic duct lymph flow circumvents a major lymph impediment to lymph flow (i.e. high central venous pressure) and therefore considerably overestimates in vivo central lymph flow in this condition.

Animals↗
PubMed1970

Thoracic duct changes in schistosomal hepatic fibrosis.

The changes in the thoracic duct were studied in schistosomatic hepatic fibrosis, particularly in cases with ascites. The postmortem findings, lymphangiography, and clinical thoracic duct cannulation showed that, particularly in cases with ascites, the thoracic duct is dilated, pressure within is raised, and the lymph flow is increased. The significance of these findings is discussed in relation to the site and the treatment of ascites.

Ascites↗
PubMed1983

CT of the thoracic duct.

The ability of computed tomography to demonstrate the normal anatomy of the thoracic duct was investigated after lymphangiography in 20 patients without evidence of chest diseases on the plain films. The entire opacified thoracic duct can be easily imaged from its origin at the thoraco-abdominal level, up to its arch, which enters the venous blood stream, usually at the left subclavian-jugular confluent. Variations of the arch of the duct have been observed in our series. The ability to detect the non-opacified duct with CT was also assessed in 80 patients. Imaging of part or totality of the lower, mid and upper segments of the thoracic duct is possible respectively in 81, 54 and 69 per cent of subjects. The arch of the duct was displayed in 57 per cent. Knowledge of the normal anatomy of the thoracic duct is important since it can be involved in many diseases of the posterior mediastinum and of the thoracic outlet.

Adult↗
PubMed1991

Thoracic duct cyst of the neck: a case report.

A thoracic duct cyst was excised from the left side of the neck of a 63-year-old woman. It was 6.5cm in length and 3.5cm in width, and was located behind the common carotid artery and jugular vein. The proximal portion of the thoracic duct with a narrowed lumen was in direct contact with the lateral surface of the cyst and the venous angle. The lower end of the cyst extended into the mediastinum to immediately above the aortic arch; the inferior portion of the thoracic duct descended from the bottom of the cyst into the mediastinum behind the aorta. The cyst was unilocular with a fluid content high in triglyceride (3350mg/dl). Its wall was muscular and permeated with lymphatic vessels.

Cysts↗
PubMed1995

Progressive lymphangiectasis and recurrent chylothorax in a dog after thoracic duct ligation.

A 2-year-old Bernese Mountain Dog was examined to determine the cause of bilateral pleural effusion. Torsion was diagnosed, and a lobectomy of a lung lobe was performed. Chylothorax developed 12 days after lung lobectomy. Mesenteric lymphangiography revealed lymphangiectasis Lymphangiography immediately after surgical thoracic duct was completely obstructed, but chylothorax persisted after thoracic duct ligation. Lymphangiography was repeated 50 days after ligation of the thoracic duct and revealed multiple patent thoracic duct branches and progressive lymphangiectasis. A second attempt to ligate the thoracic duct caused the effusion to become serosanguineous. A pleuroperitoneal shunt with a manually operated pump chamber was used to remove the pleural effusion. Chylothorax was again detected 50 weeks after placement of shunt. Mesenteric lymphangiography revealed multiple patent thoracic duct branches and a lymphatic plexus that extended across the thoracic cavity.

Animals↗
PubMed2004

[Thoracic duct valves in man and albino rat].

The aim of this research was to determine the number, structure and position of valves along the whole length of thoracic duct in man and albino rat. The study was performed using the material obtained from 30 human corpses of men and women aged 17 to 60 years with no history of cardiovascular pathology and from 60 outbred albino rats of both sexes aged 5 to 12 months. Material was fixed in 10% neutral formalin. Anterior wall of thoracic duct was longitudinally dissected. Thoracic duct of 30 rats was stained with gallocyanin-chrome alum, in the remaining animals it was studied after its injection with blue Gerota's mass. In most cases, the valves consisted of two semilunar cusps. Thoracic duct was found to contain on the average 14.7+/-0.2 valves in man and 11.9+/-0.2 valves in rat. Most of all valves were found in the upper (anterior) 1/3 of the thoracic duct, least--in its middle part. This seems to be determined by anatomo-topographic features of the different parts of thoracic duct.

Adolescent↗
PubMed2005

Resection of a thoracic duct lymphangioma using video-assisted thoracoscopic surgery.

Thoracic duct lymphangioma is a rare mediastinal tumor. Most patients are asymptomatic. Symptoms may include dysphagia, dyspnea, cough, or chest pain. Workup may include chest computed tomography or lymphangiography, or both. Surgery should be considered the treatment of choice. We present a 60-year-old man with a 2.4-cm mass in the retro-cardiac space to the right of the esophagus. The patient underwent a thoracoscopic resection of the mass with ligation of the thoracic duct. We conclude that video-assisted thoracoscopic surgery allows for safe evaluation and resection of mediastinal pathology.

Humans↗