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Clinical implications of thoracic duct dilatation in patients with chronic liver disease

Seung Woon Park1, Tae Hyung Kim1, Soo-Youn Ham2

  • 1Department of Internal Medicine, Korea University College of Medicine.

Medicine
|June 3, 2020
PubMed

Insights

The degree of thoracic duct dilatation (DTD) correlates with chronic liver disease progression. Visible DTD on CT scans is linked to cirrhosis, varices, and ascites, suggesting impaired lymph drainage.

Area of Science:

  • Medical Imaging
  • Gastroenterology
  • Lymphatic System Research

Background:

  • Chronic liver disease (CLD) encompasses a spectrum of conditions leading to liver damage and dysfunction.
  • Thoracic duct dilatation (DTD) is a potential indicator of lymphatic system compromise.
  • The relationship between DTD and CLD progression, particularly cirrhosis and portal hypertension, requires further elucidation.

Purpose of the Study:

  • To investigate the association between the degree of thoracic duct dilatation (DTD) and the progression of chronic liver disease.
  • To determine if DTD measurements on chest CT scans can serve as a biomarker for cirrhosis, portal hypertension, and ascites.

Main Methods:

  • A cross-sectional, retrospective study enrolled 179 patients with CLD who underwent chest CT.
  • Thoracic duct dilatation was graded (0, 1, or 2) based on the maximum transverse diameter of the left distal thoracic duct.
  • Binary logistic regression analysis was used to assess the relationship between DTD grades and clinical outcomes.

Main Results:

  • A higher proportion of Grade 2 DTD was observed in patients with advanced CLD, particularly cirrhosis.
  • Visible DTD (any grade) was significantly associated with the presence of cirrhosis (OR, 3.809) and significant varices (OR, 3.211).
  • Grade 2 DTD was more frequent in patients with ascites (OR, 2.788), though a notable percentage of cirrhotic patients with ascites had no visible DTD.

Conclusions:

  • The degree of thoracic duct dilatation is significantly associated with CLD progression to cirrhosis and portal hypertension.
  • DTD visualized on chest CT may indicate advanced liver disease and lymphatic dysfunction.
  • Impaired lymph drainage via the thoracic duct may contribute to the development and characteristics of ascites in CLD patients.

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