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Thoracic Duct Tear
Allen Heeger, DO
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Definitions

                • Thoracic duct: Transports chyle from intestinal lacteals; vertically traverses and crosses visceral mediastinum, drains into left subclavian vein
                • Thoracic duct tear: Thoracic duct disruption
                  • Chylothorax, chylopericardium, chylous ascites
              • Anatomy

                • Thoracic duct extends vertically from cisterna chyli in right retrocrural space, crosses midline visceral mediastinum near level of T6, ascends to thoracic inlet along left aspect of trachea and drains into left subclavian vein near junction of left internal jugular vein

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Nonvascular Interventions

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          Selected References

                                          1. Novelli PM et al: Interventional therapies for thoracic duct injury and intractable chylothorax. J Thorac Imaging. 34(4):258-65, 2019
                                          2. Johnson OW et al: The thoracic duct: clinical importance, anatomic variation, imaging, and embolization. Eur Radiol. 26(8):2482-93, 2016
                                          3. Euathrongchit J et al: Nonvascular mediastinal trauma. Radiol Clin North Am. 44(2):251-8, viii, 2006
                                          4. Kumar S et al: Thoracoscopic management of thoracic duct injury: Is there a place for conservatism? J Postgrad Med. 50(1):57-9, 2004
                                          5. Patten RM et al: Isolated traumatic rupture of the cisterna chyli: CT diagnosis. J Comput Assist Tomogr. 23(5):701-2, 1999
                                          6. Sachs PB et al: Diagnosis and localization of laceration of the thoracic duct: usefulness of lymphangiography and CT. AJR Am J Roentgenol. 157(4):703-5, 1991
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Definitions

                                                        • Thoracic duct: Transports chyle from intestinal lacteals; vertically traverses and crosses visceral mediastinum, drains into left subclavian vein
                                                        • Thoracic duct tear: Thoracic duct disruption
                                                          • Chylothorax, chylopericardium, chylous ascites
                                                      • Anatomy

                                                        • Thoracic duct extends vertically from cisterna chyli in right retrocrural space, crosses midline visceral mediastinum near level of T6, ascends to thoracic inlet along left aspect of trachea and drains into left subclavian vein near junction of left internal jugular vein

                                                      IMAGING

                                                      • General Features

                                                        • Radiographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Nonvascular Interventions

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  Selected References

                                                                                  1. Novelli PM et al: Interventional therapies for thoracic duct injury and intractable chylothorax. J Thorac Imaging. 34(4):258-65, 2019
                                                                                  2. Johnson OW et al: The thoracic duct: clinical importance, anatomic variation, imaging, and embolization. Eur Radiol. 26(8):2482-93, 2016
                                                                                  3. Euathrongchit J et al: Nonvascular mediastinal trauma. Radiol Clin North Am. 44(2):251-8, viii, 2006
                                                                                  4. Kumar S et al: Thoracoscopic management of thoracic duct injury: Is there a place for conservatism? J Postgrad Med. 50(1):57-9, 2004
                                                                                  5. Patten RM et al: Isolated traumatic rupture of the cisterna chyli: CT diagnosis. J Comput Assist Tomogr. 23(5):701-2, 1999
                                                                                  6. Sachs PB et al: Diagnosis and localization of laceration of the thoracic duct: usefulness of lymphangiography and CT. AJR Am J Roentgenol. 157(4):703-5, 1991