Lymphocoele of the thoracic duct: a cause of left supraclavicular fossa

Offiah, Curtis; Twigg, Steven

doi:10.1259/bjr/28200085

Cited by 13 publications

(10 citation statements)

References 7 publications

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“… 2,4,5 Distal obstruction of the duct has been reported as a cause for cyst development, 6 but other authors are more skeptical of this possibility. 5,7 TD ligation is often performed without subsequent development of cysts proximally, theoretically supporting the view that other factors must be present for the development of CTDC to occur.…”

Section: Discussionmentioning

confidence: 87%

Management of cervical thoracic duct cyst with cyst-venous anastomosis

Dortch

Eck

Hakaim

et al. 2014

International Journal of Surgery Case Reports

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INTRODUCTIONCervical thoracic duct cyst (CTDC) is a rare cause of lateral neck mass. Surgical excision with ligation of the cervical thoracic duct is the current standard for definitive management with symptomatic patients. We report the first case of an alternative method of management performing a cyst venous anastomosis for decompression.PRESENTATION OF CASEA 77 year old female presented with a six month history of left arm pain, swelling and a left-sided cystic neck mass. She was treated with cyst-venous anastomosis between the cyst wall and the left internal jugular vein. At two year follow-up, she has had resolution of pain and no recurrence of the mass.DISCUSSIONMany potential etiologies have been proposed for CTDC, though surgical management of this rare problem has consistently required cyst excision and thoracic duct ligation. Few innovative modes of therapy have been developed to address this problem in a less invasive manor. Maintaining a more natural thoracic duct anatomy decreases the likely of complications associated with duct ligation.CONCLUSIONCyst-venous anastomosis for the management of CTDC provides an effective, novel form of treatment which maintains the integrity of the thoracic duct and avoids potential complications associated with duct ligation.

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Section: Discussionmentioning

confidence: 87%

Management of cervical thoracic duct cyst with cyst-venous anastomosis

Dortch

Eck

Hakaim

et al. 2014

International Journal of Surgery Case Reports

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“…7 Proposed theories as to the etiology include congenital weakness in the duct wall, an acquired inflammatory process, as well as postoperative or traumatic disruption of lymphatic drainage. 8 The fluid within a lymphocele may be milky or straw-colored, as in this case. In a series of percutaneously treated abdominal and pelvic lymphoceles, 9 of 11 had clear straw-colored fluid rather than milky fluid and the location of the lymphocele seemed to matter.…”

Section: Discussionmentioning

confidence: 98%

Direct puncture sclerotherapy of a thoracic duct cyst presenting as an enlarging left supraclavicular mass

2013

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A 58-year-old woman presented with a palpable mass at the base of the left neck which she had first noticed 12 years previously, shortly after abdominal surgery. The mass had progressively enlarged, resulting in dysphagia, dyspnea and occasional pain. Imaging showed a septated but otherwise simple cystic mass extending into the mediastinum and containing lymphocytic fluid on aspiration. A diagnosis of the rare entity of a thoracic duct cyst with supraclavicular extension was made. The patient opted for percutaneous sclerotherapy of the lesion, which was performed using glacial acetic acid. This resulted in complete resolution of the mass with one treatment. After exclusion of other causes of cystic left supraclavicular masses including cystic neoplasms and pseudoaneurysms of the carotid or subclavian arteries, direct puncture sclerotherapy can be safe and effective.

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“…A left-sided supraclavicular cystic mass elicits a wide range of differential diagnoses from branchial cleft cyst, lymphangioma, cystic hygroma, lymphatic malformations, lymphomatous lymph node, cystic lymphadenopathy, nerve sheath tumour, carotid or subclavian artery pseudoaneurysm, cyst from thymus or parathyroid glands, to a sinister lesion such as cystic nodal metastasis (especially level 5B lymph node involvement from papillary thyroid carcinoma and squamous cell carcinoma of the upper aerodigestive tract, and infraclavicular tumours such as pulmonary, abdominal, or pelvic in origin) [2, 3]. Supraclavicular extension of the thoracic duct is quite rare, thus CTDC is not expected to rank high in the list of conditions to consider initially.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Variations in the Management of Cervical Thoracic Duct Cyst

2020

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We present an uncomplicated case report of a cervical thoracic duct cyst (CTDC) in a 61-yearold woman treated with surgical excision. We reviewed 47 similar cases since it was first described in 1964 and evaluated the different diagnostic and management approaches. Previously believed to be the gold standard tool for evaluation, lymphangiography is now less popular due to advent of high-resolution imaging combined with aspiration techniques. CTDC treatment includes observation, low-fat diet, repeated aspirations, external pressure, sclerotherapy, embolisation, and surgical intervention. The preferred management of choice to date is surgical excision.

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Lymphocoele of the thoracic duct: a cause of left supraclavicular fossa

Cited by 13 publications

References 7 publications

Management of cervical thoracic duct cyst with cyst-venous anastomosis

Management of cervical thoracic duct cyst with cyst-venous anastomosis

Direct puncture sclerotherapy of a thoracic duct cyst presenting as an enlarging left supraclavicular mass

Variations in the Management of Cervical Thoracic Duct Cyst

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