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The thoracic duct: clinical importance, anatomic variation, imaging, and embolization
Oren W Johnson1, Jeffrey Forris Beecham Chick2,3, Nikunj Rashmikant Chauhan1,4
1Department of Radiology, Division of Angiography and Interventional Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
The thoracic duct, the body's largest lymphatic vessel, can be injured, leading to chylothorax. Embolization is often required to treat these disruptions, requiring knowledge of its anatomy and variants.
Area of Science:
- Anatomy and Physiology
- Interventional Radiology
- Lymphatic System
Background:
- The thoracic duct is the primary conduit for lymphatic fluid, crucial for immune function and nutrient transport.
- Anatomical variations are common, impacting its visibility and increasing the risk of iatrogenic injury during procedures.
- Thoracic duct disruption can lead to chylothorax, causing significant morbidity including immunosuppression, malnutrition, and respiratory compromise.
Purpose of the Study:
- To provide a comprehensive review of the thoracic duct's clinical significance.
- To detail common and uncommon anatomical variants and their implications.
- To outline the indications, techniques, and outcomes of thoracic duct embolization.
Main Methods:
- Review of clinical importance, embryologic origin, and typical thoracic duct anatomy.
- Depiction of anatomical variants and their clinical relevance.
- Outline of causes of thoracic duct injury and embolization indications.
- Review of thoracic duct embolization techniques (pedal and intranodal).
- Presentation of success rates and complications.
Main Results:
- The thoracic duct's anatomy is variable, with typical courses present in only 40-60% of individuals.
- Injuries to the thoracic duct frequently result in chylothorax, necessitating intervention.
- Embolization is a primary treatment for thoracic duct disruptions, with established interventional techniques.
Conclusions:
- Understanding thoracic duct anatomy and its variants is critical for interventional procedures.
- Thoracic duct embolization is an effective treatment for chylothorax resulting from duct disruption.
- This review equips practitioners with knowledge for diagnosing and managing thoracic duct injuries.
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