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Chylothorax
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Depending on the size of the patient, either 3 mm or 5 mm instruments are used to mobilize the lung and take down any adhesions. The inferior pulmonary ligament can be divided with diathermy, if necessary, to optimize exposure. The esophagus is visualized with the assistance of an orogastric tube placed by the anesthesiologist at induction. On the right side, the thoracic duct is located between the azygous vein and the aorta (Figure 18.4).
How much should diagnostic investigations incorporate visceral involvement for Klippel–Trenaunay syndrome?
Published in Byung-Boong Lee, Peter Gloviczki, Francine Blei, Jovan N. Markovic, Vascular Malformations, 2019
Pathology and leakage from the thoracic duct may be recognized with the aid of transnodal lymphography or transnodal MRI. The contrast medium is lipiodol for the radiographic investigation and gadolinium for MRI, which can be acquired with the angiographic sequences.
Thoracic Duct: Conditions Affecting function
Published in Waldemar L. Olszewski, Lymph Stasis: Pathophysiology, Diagnosis and Treatment, 2019
The thoracic duct functions as an appendage of the cardiovascular system, transporting to blood absorbed lipid, immunologically active cells and protein and plasma protein absorbed into lymph vessels from capillary filtrate (see Figure 1). Disorders which interfere with this transport function are considered in this chapter. Thoracic duct dysfunction in some of these disorders occurs at a normal rate of lymph production—conveniently termed “low flow failure”, while in others the dysfunction is the direct result of an excessive rate of lymph production—termed “high flow failure”.1
Thoracic Lymph Duct Catheterization with a Venous Shunt in the Nonhuman Primate
Published in Journal of Investigative Surgery, 2022
Jon Ehrmann, Claudia Generaux, Sharon Ostergaard, Wendy Johnson, Anne Rose, Vince Mendenhall
The anatomical variance of lymphatic ducts is well documented in the literature [20,21]. Significant variations exist in the exact anatomical arrangement of the lymphatic system, both between species, and between individuals within a species. This variation can lead to surgical complications when trying to access the lymphatics and reproducibly assess the extent of lymphatic drug transport. We elected to use the thoracic lymph duct as our site for catheterization due to its documented size and location in the NHP. Variations in the size and location of the thoracic duct were encountered. Most of the animals undergoing surgery had the duct located subpleurally between the aorta and azygous vein. In the animals that did not have a duct in the usual location, we found a few ducts dorsal and caudal to the aorta, one was found crossing ventrally over the aorta and approximately 30% of the animals had no detectable duct present in the thorax. The authors theorize that the animals with no detectable duct in the thorax had very small collateral ducts instead that joined further upstream in the cervical region prior to emptying into the jugular vein. Additionally, the average weight of animals with appropriate anatomy was 5.6 kg and those with no duct or too small of a duct for catheterization was 6.05 kg. Therefore, the authors do not feel weight was a recipient factor to be considered in subject selection.
Chylothorax in Behçet’s disease
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2021
Sophie B. Kermelly, Marie-Ève Boucher, François Côté, François Maltais
Pleural fluid is physiologically produced in small quantity and its accumulation is prevented by parietal pleural lymphatics. Once entering the lymphatic system, the pleural fluid blends with the chylous content from the small intestine.11 In a majority of patients, the main lymphatic vessel, the thoracic duct drains its chyle into the left subclavian vein at the junction with the left jugular vein.12 The pathophysiological phenomenon beneath chylothorax in Behçet’s Disease is thought to be caused by increased pressure in the lymphatic low flow system where thrombosis of the superior vena cava creates a backflow through the subclavian vein, therefore rising the pressure within the thoracic duct, compromising its drainage, a phenomenon called “chylous reflux.” This phenomenon leads to chyle accumulation in the thorax small lymphatic vessels and in the pleural space (Figure 5).13 Chylous pleural effusions in Behçet’ Disease are more frequently bilateral or left-sided, as it was the case for our patient. In cases of reported chylothoraces, chylous pericardial effusion can be associated in 55% of reported Behçet chylothorax.6
The effect of prophylactic thoracic duct ligation during esophagectomy on the incidence of chylothorax and survival of the patients: an updated review
Published in Postgraduate Medicine, 2021
Lei Liu, Longbo Gong, Miao Zhang, Wenbin Wu
There were several limitations that should be identified. First, there was only one RCT in the meta-analysis; thus, the results should be interpreted with caution as it might yield misleading information due to the significant heterogeneity, inherent bias, and limited sample size of the included reports. In addition to tumor stage and lymph node status of the patients, intraoperative thoracic duct injury might be an important indication during surgical decision-making of TDL. However, all these issues could not be obtained from the included reports. Second, non-English/non-Chinese relevant articles might be neglected. Third, the detection and diagnostic criteria of chylothorax varied in different studies. More importantly, the indications for TDL probably varied among the retrieved articles partly due to the lymph node status of the patients and the surgical experience/preference of the surgeons. Meanwhile, there are a lot of items correlated with the occurrence of chylothorax including but not limited to the variable anatomy of the thoracic duct and the extent/quality of mediastinal lymphadenectomy. Based on the currently available evidence, the actual benefit of TDL largely remains unanswered. Therefore, further well-designed multicenter trials are warranted to verify the exact effect of TDL during thoracic cancer surgery. In addition, preclinical researches for better understanding of the mechanisms of TDL-related harmful effect are also warmly welcomed.