Variations in the Management of Cervical Thoracic Duct Cyst

Abstract

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.

Malformaciones linfáticas del ducto torácico cervical tratadas mediante escleroterapia

“…Con respecto al tratamiento, aunque la literatura reporta pocos casos, la mayoría de los descritos fueron manejados quirúrgicamente 5,12,13,[20][21][22] . En nuestro centro, sin embargo, se trató como primera opción con escleroterapia, que fue efectiva en estos dos pacientes con ML con conexión al ducto torácico.…”

“…Generalmente evolucionan con crecimiento lento, sin dolor ni complicaciones infecciosas ni hemorrágicas. En ocasiones se presentan con sintomatología secundaria a la compresión de estructuras adyacentes, como disnea, palpitaciones, edema local, disfagia u otras 13 . and the technique used in the procedure are described in detail.…”

Recurrent thoracic duct cyst of the left supraclavicular fossa

“…In most of our patients, triggering factors were a high-fat diet and combined oral contraceptive use. [ 1 , 16 , 17 , 20 ] It is important to note that the cases involved combined oral contraceptive use dated from 1995 which was at a time when the average dosage of estrogen was high. A high-fat diet can be a triggering factor because it increases pressure in the thoracic duct canal [ 1 ] with the resulting production of chyle that is composed mainly of lymphocytes and lipid-rich fats.…”

“…The diet should exclude food rich in fat. If long-chain triglycerides are completely excluded from the diet, medium-chain triglyceride supplementation should be introduced [ 4 , 17 , 23 ] because medium-chain triglycerides are directly absorbed into the portal system. [ 1 , 23 ] In our study, a dietary regime with or without total exclusion of long-chain triglyceride was offered systematically as a first step because it is safe and usually enough to control the disease.…”

“…Moreover, this disease has probably been underestimated and underdiagnosed since only 6 observed cases at 3 internal medicine departments were found over a 10-year period in the medical facilities. It should, however, remain a diagnosis of exclusion and it may be therefore crucial to exclude differential diagnoses such as a tumor-like metastatic lesions, a parathyroid or thymic cyst, [6][7][8][17][18][19] sequelae of a prior injury (whether surgical or other including birthing, whiplash and stretching), [8,15,18] lymphangioma [6,17,19] or hematoma. [11] In these cases, a clinical examination and medical imaging during the acute phase should guide a clinician.…”