Abstract

US imaging of the thoracic duct helps to describe functional abnormalities and may be helpful in the evaluation of chylothorax and chylous ascites.

Purpose

To assess ultrasonographic (US) examination results of the cervical part of the thoracic duct, to provide standard diameters, and to evaluate the diameter of the cervical thoracic duct in certain diseases suspected to involve an abnormal load of chyle (liver, heart, and inflammatory bowel diseases).

Materials and Methods

The study was approved by the institutional review committee, and written informed consent was obtained from all subjects. Diameter and variations of the cervical thoracic duct were assessed by using US in 265 healthy volunteers (age range, 21–82 years) from a population-based study, in 196 subjects with documented liver cirrhosis (age range, 19–87 years), in 68 subjects with chronic hepatitis (age range, 17–73 years), in 39 subjects with congestive heart failure (age range, 46–85 years), and in 17 subjects with inflammatory bowel disease (age range, 18–66 years). US examinations were performed with high-resolution linear probes (7–12 MHz).

Results

A standard imaging approach guided by anatomic structures was established. Dynamic imaging of the chyle flow and valve function was possible. The thoracic duct was visualized in 564 (96%) of 585 examinations. The average thoracic duct diameter in healthy volunteers was 2.5 mm, which was independent of the subjects' age. The diameter was significantly higher in subjects with congestive heart failure (6.3 mm, P < .0001) and liver cirrhosis (5.6 mm, P < .0001). Anatomic variations were present in 27% of subjects.

Conclusion

High-resolution US with linear probes allows assessment of the cervical thoracic duct with high detection rates. Recognition of local anatomy, diameter, and chyle flow may aid functional assessment.

Supplemental material: http://radiology.rsnajnls.org/cgi/content/full/radiol.2531082036/DC1

References

1. Groves LK, Effler DB. Primary chylopericardium. N Engl J Med 1954; 250: 520– 523. Crossref, Medline, Google Scholar
2. Marsac JH, Bismuth V, Huchon GJ. Pleural chylous effusion. In: Chretien J, Bignon J, Hirsch A eds. Lung biology in health and disease. New York, NY: Marcel Dekker, 1986; 233– 249. Google Scholar
3. Nix JT, Albert M, Dugas JE, Wendt DL. Chylothorax and chylous ascites: a study of 302 selected cases. Am J Gastroenterol 1957; 28: 40– 53. Medline, Google Scholar
4. Servelle M, Turiaf J, Rouffilange Het al.. Chyluria in abnormalities of the thoracic duct. Surgery 1963; 54: 536– 549. Medline, Google Scholar
5. Van Pernis PA. Variations of the thoracic duct. Surgery 1949; 26: 806– 809. Medline, Google Scholar
6. Wirth W, Frommhold H. Thoracic duct and its variations: lymphography studies [in German]. Fortschr Geb Rontgenstr Nuklearmed 1970; 112: 450– 459. Crossref, Medline, Google Scholar
7. Wirth W, Kubik S. Lymphographic roentgen anatomy. In: Viamonte M, Rüttimann A, Agbaba M eds. Atlas of lymphography. Stuttgart, Germany: Thieme-Verlag, 1980; 71– 89. Google Scholar
8. Parsons FG, Sargent PW. On the termination of the thoracic duct. Lancet 1909; 173: 1173– 1174. Crossref, Google Scholar
9. Witte CL, Witte MH, Unger ECet al.. Advances in imaging of lymph flow disorders. RadioGraphics 2000; 20: 1697– 1719. Link, Google Scholar
10. Clement O, Luciani A. Imaging the lymphatic system: possibilities and clinical applications. Eur Radiol 2004; 14: 1498– 1507. Crossref, Medline, Google Scholar
11. Liu ME, Branstetter BF, Whetstone J, Escott EJ. Normal CT appearance of the distal thoracic duct. AJR Am J Roentgenol 2006; 187: 1615– 1620. Crossref, Medline, Google Scholar
12. Hayashi S, Miyazaki M. Thoracic duct: visualization at nonenhanced MR lymphography—initial experience. Radiology 1999; 212: 598– 600. Link, Google Scholar
13. Winkler R, Luning M, Tallroth K, Korhola O. Lymphographic representation of the thoracic duct: study of course and variants (author's transl) [in German]. Radiol Diagn (Berl) 1978; 19: 206– 216. Medline, Google Scholar
14. Zironi G, Cavalli G, Casali Aet al.. Sonographic assessment of the distal end of the thoracic duct in healthy volunteers and in patients with portal hypertension. AJR Am J Roentgenol 1995; 165: 863– 866. Crossref, Medline, Google Scholar
15. Krawczak M, Nikolaus S, von Eberstein H, Croucher PJ, El Mokhtari NE, Schreiber S. PopGen: population-based recruitment of patients and controls for the analysis of complex genotype-phenotype relationships. Community Genet 2006; 9: 55– 61. Crossref, Medline, Google Scholar
16. Rouviére H. Anatomie des lymphatiques de l'homme. Paris, France: Masson, 1932. Google Scholar
17. Viamonte M, Rüttimann A, Agbaba M. Atlas of lymphography. Stuttgart, Germany: Thieme, 1980. Google Scholar
18. Zemel R, Gutelius JR. Anatomy and function of the thoracic duct: venous junction. Surg Forum 1965; 16: 138– 139. Medline, Google Scholar
19. Wendelhag I, Gustavsson T, Suurkula M, Berglund G, Wikstrand J. Ultrasound measurement of wall thickness in the carotid artery: fundamental principles and description of a computerized analysing system. Clin Physiol 1991; 11: 565– 577. Crossref, Medline, Google Scholar
20. Rubin D, Helwig U, Nothnagel Met al.. Postprandial plasma adiponectin decreases after glucose and high fat meal and is independently associated with postprandial triacylglycerols but not with – 11388 promoter polymorphism. Br J Nutr 2008; 99: 76– 82. Crossref, Medline, Google Scholar
21. Cha JH, Moon WK, Cho Net al.. Differentiation of benign from malignant solid breast masses: conventional US versus spatial compound imaging. Radiology 2005; 237: 841– 846. Link, Google Scholar
22. Cha JH, Moon WK, Cho Net al.. Characterization of benign and malignant solid breast masses: comparison of conventional US and tissue harmonic imaging. Radiology 2007; 242: 63– 69. Link, Google Scholar
23. Liasis N, Klonaris C, Katsargyris Aet al.. The use of speckle reduction imaging (SRI) ultrasound in the characterization of carotid artery plaques. Eur J Radiol 2008; 65: 427– 433. Crossref, Medline, Google Scholar
24. Gottlieb MI, Greenfield J. Variations in the terminal portion of the human thoracic duct. AMA Arch Surg 1956; 73: 955– 959. Crossref, Medline, Google Scholar
25. Langford RJ, Daudia AT, Malins TJ. A morphological study of the thoracic duct at the jugulo-subclavian junction. J Craniomaxillofac Surg 1999; 27: 100– 104. Crossref, Medline, Google Scholar
26. Takahashi H, Kuboyama S, Abe H, Aoki T, Miyazaki M, Nakata H. Clinical feasibility of noncontrast-enhanced magnetic resonance lymphography of the thoracic duct. Chest 2003; 124: 2136– 2142. Crossref, Medline, Google Scholar
27. Dumont AE, Witte MH. Contrasting patterns of thoracic duct lymph formation in hepatic cirrhosis. Surg Gynecol Obstet 1966; 122: 524– 528. Medline, Google Scholar
28. Schreiber HW, Koch W, Diederich K. On the significance of lymphography in the portal hypertension of liver cirrhosis [in German]. Langenbecks Arch Chir 1967; 317: 124– 139. Crossref, Medline, Google Scholar
29. Weissleder H. Pathological lymphangiograms of the ductus thoracicus [in German]. Fortschr Geb Rontgenstr Nuklearmed 1964; 101: 573– 582. Crossref, Medline, Google Scholar
30. Witte CL, White MH, Dumont AE. High flow failure of the lymph circulation. Vasc Surg 1977; 11: 130– 151. Crossref, Medline, Google Scholar
31. Dumont AE, Mulholland JH. Flow rate and composition of thoracic-duct lymph in patients with cirrhosis. N Engl J Med 1960; 263: 471– 474. Crossref, Medline, Google Scholar
32. Witte MH, Dumont AE, Clauss RH, Rader B, Levine N, Breed ES. Lymph circulation in congestive heart failure: effect of external thoracic duct drainage. Circulation 1969; 39: 723– 733. Crossref, Medline, Google Scholar
33. Seeger M, Bewig B. Images in clinical medicine. Ultrasound imaging of the thoracic duct. N Engl J Med 2008; 359: e28. Crossref, Medline, Google Scholar

Article History

Received November 18, 2008; revision requested January 8, 2009; revision received March 16; accepted March 27; final version accepted May 11.
Published in print: Sept 2009

Vol. 252, No. 3

Supplemental Material

Metrics

Downloaded 5,803 times

Altmetric Score

PDF download