Anatomy of the thoracic duct: an endosonographic study

Endoscopic Ultrasound-Guided Transesophageal Thoracic Duct Puncture in a Swine Model: A Survival Study

“…This current study carries forward a concept earlier proposed by our group 8,9 but differs from the earlier experiments because of the use of EUS alone (without contrast injections into lymphatic system) to localize the thoracic duct, use of a 25-gauge needle to puncture, and later monitoring animals for complications, in order to establish safety of this procedure. One of the theoretical hurdles in application of this technique in human subjects may be that aspiration of lymph is a very difficult process (in both animals and humans) because of the low basal flow rate of lymph in the thoracic duct (0.93 mL/ minute in a human fistula study 11 ).…”

“…EUS was performed with a linear echoendoscope (model GF-UC 30P; Olympus America Corp., Melville, NY). The thoracic duct was identified by the previously described technique, 8 with the difference that no contrast medium was injected for fluoroscopic localization of thoracic duct and that it was done using EUS alone. A 25-gauge needle (Echotip Cook Medical Inc., Winston Salem, NC) was used to puncture the thoracic duct.…”

“…This began with description and identification of the thoracic duct by endoscopic ultrasound (EUS). 8 The thoracic duct has been punctured under EUS guidance in animals. The feasibility of lymph sampling by EUS-guided puncture of the thoracic duct has been established as a proof of concept.…”

EUS-Guided Transesophageal Study of the Human Thoracic Duct Diameter After Instillation of Intraduodenal Fatty Acids (EUS-TEST Study)

“…The TDD was measured by EUS in the mediastinum by the procedure already described by the authors. 4,5 This initial TDD measurement taken at the beginning of the procedure was considered as the baseline TDD. …”

“…in 1995. 4 More recently, additional studies have been performed to demonstrate the feasibility and safety of EUS-guided TD puncture in swine models by the members of our group. 5,6 Even though the TD has been punctured by EUS, the actual process of lymph aspiration is difficult because the basal lymphatic flow through the TD is very slow (0.93 mL/minute in a human fistula study 7 ).…”