Several authors recommend interventional or surgical approaches (
thoracic duct ligation, pleurodesis, and pleuroperitoneal shunt) in such cases (3, 4).
On MRI, it showed a cystic swelling with no connection with any major vessels or the
thoracic duct (Fig.
Injury to lung parenchyma, lung vessels, aorta,
thoracic duct, and mediastinal structures including heart, esophagus, diaphragm, vagus nerve, and solid abdominal organs such as liver, spleen, bowel, and formation of bronchopleural fistula does exist.
In some cases, PB has been due to lymphatic leakage into the bronchi either from surgical trauma or pulmonary lymphatic abnormalities, with resolution of the condition after ligation of the
thoracic duct [1].
In the present case, pericardiectomy combined with
thoracic duct ligation and pleurodesis cured chylous ascites and chylothorax caused by constrictive pericarditis, which has never been previously described.
Perhaps the most celebrated lecturer associated with the university's heyday of anatomical research, the Danish physician and theologian, Thomas Bartholin (1616-1680), is primarily renowned for his discovery of the lymphatic system and for his detailed description of the
thoracic duct. A prolific author, Bartholin published widely on topics ranging from theology to refrigeration anesthesia.
Lymphoedema is a condition of localised fluid retention and tissue swelling caused by a compromised lymphatic system, which normally returns interstitial fluid to the
thoracic duct, then the bloodstream.
(1,2) They most commonly occur on the left side and are less likely on the right side, where the right lymphatic duct drainage occurs or rarely where the
thoracic duct terminates into the right internal jugular vein.
While some cases of chylous effusions are idiopathic, most are caused by
thoracic duct damage due to nontraumatic (e.g., malignancy, primarily lymphoma) or traumatic (e.g., surgical procedures or penetrating injuries) events (3).
Lymph from the lower part of the body drains into the
thoracic duct. This duct arises from the cisterna chyli, which lies between the aorta and the inferior vena cava anterior to the bodies of the first and second lumbar vertebrae.
Distant nodal metastases are possible via flow through the
thoracic duct. Emboli can flow to regional lymphatics, then to the
thoracic duct and arrive in the head and neck region by retrograde flow through intercostal, mediastinal, or supraclavicular lymph vessels.
Synopsis: Lymphedema is a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system, which normally returns interstitial fluid to the
thoracic duct, then the bloodstream.