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Ultrasound analysis of cervical thoracic duct for patients with constrictive pericarditis and chylothorax

Yingying Wang1, Binyu Zheng1, Xiaoning Zhao1

  • 1Department of Ultrasonography, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.

Journal of Clinical Ultrasound : JCU
|March 13, 2024
PubMed

Insights

Ultrasound reveals that thoracic duct dilation and regurgitation, linked to elevated central venous pressure, may cause chylothorax in constrictive pericarditis patients.

Area of Science:

  • Cardiology
  • Radiology
  • Thoracic Surgery

Background:

  • Constrictive pericarditis can lead to chylothorax, a serious condition involving lymphatic fluid in the pleural space.
  • The exact mechanism linking constrictive pericarditis to chylothorax requires further elucidation.
  • Ultrasound has emerged as a valuable tool in assessing thoracic structures.

Purpose of the Study:

  • To investigate the ultrasound characteristics of the thoracic duct in patients with constrictive pericarditis and chylothorax.
  • To correlate these ultrasound findings with central venous pressure and pleural effusion status.

Main Methods:

  • Retrospective analysis of patients categorized into non-pleural effusion, chylothorax, and non-chylothorax groups.
  • Conventional ultrasound to measure inferior vena cava diameter/collapse and left cervical thoracic duct diameter/valve function.
  • Contrast ultrasonography to assess thoracic duct reverse flow.

Main Results:

  • Chylothorax was present in 21.9% of the studied patients.
  • Significant differences in thoracic duct diameter and central venous pressure parameters were observed across groups.
  • Left cervical thoracic duct diameter correlated with central venous pressure; contrast ultrasonography effectively quantified reverse flow.

Conclusions:

  • Thoracic duct dilation and regurgitation, driven by elevated central venous pressure, are implicated in chylothorax development in constrictive pericarditis.
  • These findings suggest a mechanism of chyloreflux disorder contributing to chylothorax.
  • Ultrasound provides a quantitative method to assess these hemodynamic changes.
Abstract

Keywords:
cervical thoracic ductchylothoraxconstrictive pericarditisultrasound

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