The immune and lymphatic systems, infection and sepsis
Ian Peate, Helen Dutton in Acute Nursing Care, 2014
The lymphatic system recycles approximately 2– 4L per day of interstitial fluid back into the bloodstream (Marieb and Hoehn 2010). Lymphatic vessels, like peripheral veins, contain valves which ensure the one-way movement of lymph back into the venous system. Lymph fluid drains into collecting vessels, then into several lymphatic trunks and finally into two main collecting ducts: the right lymphatic duct;the thoracic duct. The right lymphatic duct drains the right upper arm, the right side of the head, thorax, subclavian and jugular regions and opens into the right subclavian vein. The larger thoracic duct drains into the left subclavian vein. Over two-thirds of lymph from the body drains into this duct via the right lymphatic duct.
Milroy Disease
Dongyou Liu in Handbook of Tumor Syndromes, 2020
As a drainage network that begins in the interstitial spaces and ends in the great veins of the neck or thorax, the lymphatic system is composed of lymphatic vessels (including initial lymphatics, pre-collectors, and collecting lymphatics, with unidirectional valves dividing the collecting vessels into segments called lymphangions, and collecting lymphatics pumping the lymph through the regional lymph nodes and reaching the thoracic duct or the right lymphatic trunk), lymph nodes (which clean and filter lymph, a clear fluid containing infection-fighting white blood cells originated from plasma), tonsils (which act as the first line of immune defense against invading pathogens), adenoids, spleen (which as a blood filter controls red blood cells and blood storage in the body, and helps fight infection) and thymus (which stores immature lymphocytes/specialized white blood cells before maturing into active T cells to destroy infected or cancerous cells). Functionally, the lymphatic system is involved in maintenance of interstitial fluid balance (an increase in filtration or a reduction in lymphatic removal or both contributing to edema), immune surveillance (and maturation of immune cells) and absorption of fat (which is taken up by the intestinal lymphatics and transported to the venous circulation). Besides removing circulating fluid and large molecules from the extracellular spaces of almost all body tissues and transporting them to the lymph nodes, lymphatic vessels carry antigens and immune cells from the tissues as part of host defense [2–4].
Autopsy Cardiac Examination
Mary N. Sheppard in Practical Cardiovascular Pathology, 2022
The heart is supplied by a rich plexus of lymphatics. The lymphatic channels run along with the veins and drain the lymph to the pulmonary hilar lymph nodes and also directly into the thoracic duct and the left lymphatic channel. As part of the circulatory system, lymphatic vessels have particular functions in fluid homeostasis, lipid absorption, immune cell trafficking and causative agent filtration. The lymphatic vascular system consists of a compact network of blind-ended, slight-walled lymphatic capillaries and collecting lymph vessels that drain exudative protein-rich fluid from the majority of tissues that transport the lymph by way of the thoracic duct to the venous circulation. Several lymphatic endothelial markers, such as vascular endothelial growth factor receptor 3 (VEGFR-3), lymphatic vessel endothelial hyaluronic acid receptor-1 (LYVE-1), prospero-related homeobox-1 (Prox-1) and podoplanin (D2-40) are widely used in labelling lymphatics (Fig. 1.16).
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
A conservative approach to a thoracic duct injury caused by left subclavian vein catheterization
Published in Egyptian Journal of Anaesthesia, 2018
Vedran Premuzic, Ranko Smiljanic, Drazen Perkov
Thoracic duct, wide only 2–6 mm, transports lymph from the lower part of the body and mixing with fluids from intestines form a mixture called chyle and pours into venous circulation by sometimes multiple branches. Its variations are seen in more than one third of the population. Cisterna chyli is present in only 50% of humans, when absent, there are 2 or more lymph ducts. Clouse relationship with other structures leads of injury during operations, a main cause of traumatic duct injury. Other causes as malignancies and coronary artery bypass are not so common, especially injuries during catheter insertions (<1% of cases). Periprocedural central venous catheter complications are mostly related to pneumo or hematothorax, vascular injury and the catheter tip malposition and very rarely thoracic duct injury which is similar with our experiences. The rate of these complications is higher in patients with prior temporary or permanent central venous catheters on hemodialysis. Patients with chylothorax manifest with onsets of pleuritic pain or dyspnea caused by pleural effusions which can also be absent in cases with low flow chylothorax and manifest only as unspecific pleural effusions on chest X-rays [7].
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.