The effect of respiration and body position on terminal thoracic duct diameter and the lymphovenous junction: An exploratory ultrasound study

Hinton, Lucy R; O'Hagan, Lomani A; Griffiths, Andrew P; Clark, Alys R.; Phillips, Anthony R. J.; Windsor, John A.; Mirjalili, S. Ali

doi:10.1002/ca.23801

Cited by 4 publications

(3 citation statements)

References 37 publications

(48 reference statements)

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“…We did not notice significant differences between men and women. It has been also reported that the TD diameter is dependent on the respiratory phase, as well as it can dilate in diseases causing increased central venous pressure like congestive heart failure or liver cirrhosis with portal hypertension (Hinton et al, 2021; Seeger et al, 2009). This has been also confirmed in chylothorax (Yu et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

“…T A B L E 1 Summary of TD anatomy and physiology findings Sonography studies provide different perspective for the TD anatomy assessment (Hinton et al, 2021;Seeger et al, 2009). Ultrasound allowed to visualize the TD in majority of patients or healthy volunteers.…”

Section: Anatomymentioning

confidence: 99%

“…Several studies were published recently showing that the sonography may be used for the TD assessment, however there are no normative values established on how normal the TD should appear (Kochilas et al, 2014; Seeger et al, 2009; Sung et al, 2017). Most of those studies focused on assessing the difference in the TD diameter in health and disease, and very little is known on how the TD reacts to different physiological conditions (Hinton et al, 2021). Seeger et al describe the “chyle flow phenomenon,” which is a burst of hyperechogenic content visible within the lumen of a vein to which the TD drains to, reappearing in short intervals, with or without the TD being visible.…”

Section: Introductionmentioning

confidence: 99%

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Sonography for assessment of thoracic duct anatomy and physiology before and after meals

2022

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The interest in clinical anatomy of the thoracic duct (TD) has recently grown, owing to discoveries linking its morphology to pathologies such as heart failure or liver cirrhosis. In the light of this knowledge, a cost-efficient and reliable in-vivo imaging method of TD should be devised. Ultrasonography satisfies these criteria and hence is a promising tool for assessment of TD's anatomy and function. Thirty-one healthy volunteers attended the examination after 6 h of fasting and 2 h without drink. Ultrasound of the left supraclavicular fossa was performed in search of TD's orifice into the venous angle. In each case, the largest diameter, number of orifices, presence of valves, tributaries, and motility of the TD were examined. We performed examinations in three sessions: after fasting, after standardized meal and 1 h after the meal.The statistical significance has varied among the three sessions. The strongest connection was shown in the third examination. The TD was visualized in 31 cases, 35 orifices were found, most of which drained into the venous angle. Multiple orifices were seen in four cases and valves in 15 cases. Tributaries were present in 17 cases. Mean widest and orifice diameter measured 3.23 and 2.0 mm, respectively. Spontaneous peristaltic-like movements of the TD were observed in 25 cases. We demonstrated that ultrasound is useful for assessment of TD's anatomy, allowing to visualize and quantify its key features. Moreover, our study is presumably the first to capture and describe TD's motility in vivo.

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Section: Discussionmentioning

confidence: 99%

Section: Anatomymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sonography for assessment of thoracic duct anatomy and physiology before and after meals

2022

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Disorders of the Lymphatic System

Mortimer,

Gordon

2024

Rook's Textbook of Dermatology

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The lymphatic system is the body’s cleansing and recycling service. It removes toxins, waste and recycles fat and fluid. It also forms part of our immune system. The lymphatic system provides all the checks and balances for other body systems. It is the main controller of body fluid balance and it provides immunosurveillance and is responsible for creating immunity. It mobilises fat: impaired lymph drainage results in fat deposition and lymphoedema swelling is as much fat as fluid. It is also important for preventing atherosclerosis. It patrols for cancer cells; if this surveillance fails, cancer progresses. It regulates self‐tolerance, with failure resulting in autoimmune disease.

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The cisterna chyli: a systematic review of definition, prevalence, and anatomy

Moazzam

O'Hagan

Clark

et al. 2022

American Journal of Physiology-Heart and Circulatory Physiology

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Background: The cisterna chyli is a lymphatic structure found at the caudal end of the thoracic duct which receives lymph draining from the abdominal and pelvic viscera and lower extremities. In addition to being a landmark in retroperitoneal surgery it is an emerging access point to the thoracic duct for interventional radiologists. The anatomy and variations of the cisterna chyli are inconsistently reported in the literature. The aim of this study was to systematically review the prevalence and anatomy of the cisterna chyli in the literature. Methods: A systematic review was conducted, and 49 published human studies met the inclusion criteria. Studies included both healthy volunteers and patients and were not restricted by language or date. Results: The reported prevalence of the cisterna chyli is highly variable, ranging from 1.7-98% depending on study method and criteria used. Its anatomy is variable in terms of location (vertebral level of T10 to L3), size (ranging 2-32mm in maximum diameter and 13-80mm in maximum length), morphology, and tributaries. The size of the cisterna chyli increases in some disease states, though its utility as a marker of disease is uncertain. Conclusions: The prevalence and anatomical features of the cisterna chyli are highly variable in the literature, and it appears to increase in size in some disease states. The cisterna chyli is an increasingly important structure for antegrade cannulation of the thoracic duct by interventional radiologists, and a detailed understanding of its morphology, location and variability will facilitate more accurate intervention

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The effect of respiration and body position on terminal thoracic duct diameter and the lymphovenous junction: An exploratory ultrasound study

Cited by 4 publications

References 37 publications

Sonography for assessment of thoracic duct anatomy and physiology before and after meals

Sonography for assessment of thoracic duct anatomy and physiology before and after meals

Disorders of the Lymphatic System

The cisterna chyli: a systematic review of definition, prevalence, and anatomy

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