Cisterna chyli: A detailed anatomic investigation

Loukas, Marios; Wartmann, Christopher T.; Louis, Robert G.; Tubbs, R. Shane; Salter, E. George; Gupta, Ankmalika; Curry, Brian

doi:10.1002/ca.20485

Cited by 62 publications

(53 citation statements)

References 27 publications

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“…The prevalence of the cisterna chyli (CC) in CT, magnetic resonance imaging, magnetic resonance cholangiopancreaticography, lymphangiography and autopsy has been described before [2][3][4][5][6]. Two papers tried to link clinical data to the size and characteristics of the CC.…”

Section: Discussionmentioning

confidence: 99%

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The cisterna chyli: prevalence, characteristics and predisposing factors

et al. 2008

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The purpose of this study was to determine the prevalence and characteristics of the cisterna chyli (CC) in a large 3,000-patient cohort and to identify potential predisposing factors for the development of a CC. Three thousand consecutive contrast-enhanced CT examinations (1,261 women, 1,739 men, mean age 61.0 years) of the chest and/or abdomen were included in this retrospective study. Imaging characteristics of the CC (size, attenuation, location) were documented as well as clinical information (malignant disease, pattern of metastasis). A CC was found in 16.1% of the patients with an average volume of 302 microl. The mean attenuation was 4.8 Hounsfield units (HU). Twenty percent of the CC showed CT densities of 15 HU and higher. Patients with malignancies showed a significantly (p < 0.001) higher prevalence of CC (340/1,757, 19.4%) than patients with benign conditions (144/1,243, 11.6%). Especially the finding of a large CC (>1,000 microl) represents an elevated relative risk for malignancy of 1.7 (p = 0.0017). We found a significant association between malignant disease and the presence and size of a cisterna chyli. Identifying the continuity between the CC and the thoracic duct is a safer method to distinguish a CC from retrocrural lymph nodes than near-water CT attenuation alone.

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Section: Discussionmentioning

confidence: 99%

“…It has been described to be 2% in a 403-patient CT series [2], 15% in a 200-patient MRI series [3] and 83% in a recent 120-patient autopsy study [4]. Other authors focused on certain subsets of patients.…”

Section: Introductionmentioning

confidence: 97%

The cisterna chyli: prevalence, characteristics and predisposing factors

et al. 2008

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“…Chyloperitoneum is more prevalent after extensive abdominal operation involving the retroperitoneum [8]. Patients undergoing pancreatic resection develop a chyle leak in 1.8% to 11% [9] of cases, possibly due to surgical disruption of the cisterna chyli or its major tributaries located at the same level as the pancreas [10] induced by extended lymphadenectomy or dissection of the retroperitoneum. Another explanation may be the obstruction or malignant infiltration of lymphatic channels [11] with subsequent development of a lymphatic fistula that communicates with the peritoneal cavity, which is unlikely in this patient.…”

Section: Discussionmentioning

confidence: 99%

Refractory Ascites after Pancreato-Duodenectomy - Time to Rethink an Old Dogma

Meillat¹,

Ewald²,

Piana³

et al. 2017

J Clin Case Rep

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A rare case of refractory ascites caused by benign portal vein stenosis after pancreatoduodenectomy (PD) is reported. A dogma claims that ascites is found in portal hypertension with an intrahepatic block only. However, in the postoperative state, the pathophysiologic condition is altered, which made diagnosis difficult.A 69-year-old man who had undergone PD for lower bile duct carcinoma in situ, developed in postoperative course a pseudoaneurysm of the common hepatic artery successfully treated by stent graft. Six months later, the patient developed refractory ascites. CT scan revealed a severe stricture in the main trunk of the portal vein, probably due to extrinsic compression by the stent in the hepatic artery. Percutaneous transhepatic portography was performed and stent-graft was placed over the stenotic segment. Portal blood flow was corrected immediately. One week after the stenting procedure the patient was free of ascites and control physical and biochemical examination three years later is completely normal.

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“…Both these surgeries were uneventful. Cisterna chyli would have been damaged during retroperitoneal surgery 3 , leading to slow lymphatic leakage, resulting in chylous ascites.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic and critical care challenges in massive chyle leak following robotic surgery: a special case report

Hariharan¹,

Choudhary

Bhargava

2015

J. Soc. Anesth. Nep.

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A unique case report is hereby presented which entails the multi-modality management of a very rare complication of modern minimally-invasive robotic surgery. Chyle leak can be an extremely challenging problem following certain surgeries, especially in cancer patients. Medical, nutritional and/or surgical management is required to control the leak. Prolonged massive chyle leaks which do not respond to conservative management require surgical intervention. Retroperitoneal lymph node dissection is a complex procedure undertaken for lymph node clearance in germ cell tumors after primary radical surgery. Robotic surgeries have revolutionized the field of minimally invasive operations. A patient who underwent robotic nerve sparing retroperitoneal lymph node dissection for non-seminomatous germ cell tumor of the right testis, post-chemotherapy, developed a continuous large volume chylous ascites, presenting with electrolyte imbalances and hypotension. Exploratory laparotomy in the operation theatre was required for sealing the chyle leak after failure of medical and nutritional management in the intensive care unit. The main take-away message is that refractory chyle leak can occur in retroperitoneal surgeries requiring multidisciplinary management. Careful coordinated action between critical care, oncological, anesthesia and surgical teams is mandatory for a favourable outcome. Familiarity with the nuances of robotic surgery and eternal vigilance are the keys to successful conduction of complex robotic procedures.Journal of Society of Anesthesiologists of Nepal 2015; 2(2): 73-76

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Cisterna chyli: A detailed anatomic investigation

Cited by 62 publications

References 27 publications

The cisterna chyli: prevalence, characteristics and predisposing factors

The cisterna chyli: prevalence, characteristics and predisposing factors

Refractory Ascites after Pancreato-Duodenectomy - Time to Rethink an Old Dogma

Anesthetic and critical care challenges in massive chyle leak following robotic surgery: a special case report

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