A Canine Model for Lymphangiography and Thoracic Duct Access

OBJECTIVE: To evaluate the technical feasibility of intranodal lymphangiography and thoracic duct (TD) access in a canine model.MATERIALS AND METHODS: Five male mongrel dogs were studied. The dog was placed in the supine position, and the most prominent lymph node in the groin was accessed using a 26-gauge spinal needle under ultrasonography (US) guidance. If the cisterna chyli (CC) was not opacified by bilateral lymphangiography, the medial iliac lymph nodes were directly punctured and Lipiodol was injected. After opacification, the CC was directly punctured with a 22-gauge needle. A 0.018-in microguidewire was advanced through the CC and TD. A 4-Fr introducer and dilator were then advanced over the wire. The microguidewire was changed to a 0.035-in guidewire, and this was advanced into the left subclavian vein through the terminal valve of the TD. Retrograde TD access was performed using a snare kit.RESULTS: US-guided lymphangiography (including intranodal injection of Lipiodol [Guerbet]) was successful in all five dogs. However, in three of the five dogs (60%), the medial iliac lymph nodes were not fully opacified due to overt Lipiodol extravasation at the initial injection site. In these dogs, contralateral superficial inguinal intranodal injection was performed. However, two of these three dogs subsequently underwent direct medial iliac lymph node puncture under fluoroscopy guidance to deliver additional Lipiodol into the lymphatic system. Transabdominal CC puncture and cannulation with a 4-Fr introducer was successful in all five dogs. Transvenous retrograde catheterization of the TD (performed using a snare kit) was also successful in all five dogs.CONCLUSION: A canine model may be appropriate for intranodal lymphangiography and TD access. Most lymphatic intervention techniques can be performed in a canine using the same instruments that are employed in a clinical setting.

Left-Sided Cisterna Chyli: a Case Report on a Rare Normal Anatomic Structure

The cisterna chyli, a dilated lymphatic sac in the retrocrural space, is usually located to the right of the aorta. We report a case of a left-sided cisterna chyli, which was incidentally detected on the radiologic examinations of a preoperative workup for cholangiocarcinoma. Computed tomography (CT) and magnetic resonance (MR) images revealed a cisterna chyli measuring 2.5 cm in length in the left retrocrural space. The dilated lumbar lymphatics joined with the cisterna chyli, which was continuous with the left-sided thoracic duct. To the best of our knowledge, this is the second antemortem case of a left-sided cisterna chyli in literature. The cisterna chyli can mimic retrocrural lymphadenopathy, solid tumor with cystic degeneration, abscess or hematoma. The left-sided cisterna chyli should be referred to as a structure so as to be cautious in surgical approach.

Anatomical Variations Of The Human Thoracic Duct

Background and Aims: The thoracic duct is the major lymphatic duct in the human body, the variations in theorigin, course and termination of the thoracic duct are of great clinical importance during surgeries related tothe upper abdomen, posterior mediastinum and in cervical region, but still now a detailed study had not beendone in Andhra Pradesh state, it was decided to undertake this present study. Isolation of the thoracic duct andtracing the origin, course and termination were done to know more about it than already documented andthereby hoping to add more information to guide the radiologists and operating surgeons.Materials and methods: A total number of 45 cadavers were studied, of these 15 were female and 30 were malecadavers. The material consisted of adult cadavers between the ages of 42-81 from the dissection halls ofdepartment of anatomy of 3 different medical colleges in costal Andhra Pradesh.Results: The observations of the formation, course, length, vertebral levels, types of cisterna chili, and variationsin the termination in cervical region are documented in this study. Conclusion: The present findings showed agreat variability compare the previous studies. The findings noted in the present study regarding thoracic ducthad contributed to a better understanding of the anatomy of the thoracic duct and will prove definitely useful tosurgeons during surgical procedures related to the thoracic duct.

Abdominal Organ Injuries with Chyloperitoneum after Blunt Tauma: A Case Report

Chyloperitoneum or chylous ascite after trauma is a rare condition. It can develop after direct injuries of lymphatic vessels or cisterna chyli. Though isolated chyle duct injury has sometimes been reported, chyloperitoneum is generally accompanied by various kinds of damage to other intraabdominal organs. There's still no established therapeutic protocol regarding the treatment of chyloperitoneum when it is accompanied by the serious injuries of intraabdominal organs. We describe a 66-year-old male with serious intraabdominal organ injuries after blunt trauma. In our case, chyloperitoneum developed due to the injuries to the mesenteric lymph vessels and compression of cisterna chyli by hematoma around aorta.

Imaging of Cisterna Chyli and Thoracic Duct by Nonenhanced MR Lymphography / 中国普外基础与临床杂志

Objective To investigate the depiction rate of normal cisterna chyli and thoracic duct by nonenhanced MR lymphography and to describe their appearances on MR imaging.Methods Special MR hydrography sequence was added to the MR imaging protocols of 112 patients undergoing MR examination of the thorax and upper abdomen.MR imaging sequences included:①Respiratory-gated HASTE T2W sequence;②Breath-hold FLASH T1W sequence;③Respiratory-gated TSE 3D T2W sequence(3D MR hydrography sequence)in coronal plane.One hundred cases who met the inclusion criteria were included into the study for observation of the depiction rate,location and morphology of cisterna chyli and thoracic duct.Results On TSE 3D T2W imaging:①Cisterna chyli was visualized in 71/100(depiction rate 71.0%),morphologically including single-tube type 43.7%(31/71),bifurcation type(2-3 tubes)23.9%(17/71),plexus type 32.4%(23/71).Average length of the cisterna chyli was 4.5 cm.②The depiction rate of the lower segment of thoracic duct was 57.0%(57/100),average ductal diameter was 0.23 cm.③The depiction rate of upper segment of the thoracic duct was 31.0%(31/100).Conclusion As a noninvasive method for depicting the lymphatic system,nonenhaced MR lymphography(TSE 3D T2W sequence)demonstrated a high depiction rate for cisterna chyli and lower thoracic duct.Combined with axial images of HASTE and FLASH sequences,the location and morphology of these larger lymphatic ducts can be defined.