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Plutecki D, Bonczar M, Wilk J, Necka S, Joniec M, Elsaftawy A, Matuszyk A, Walocha J, Koziej M, Ostrowski P. The Anatomy of the Thoracic Duct and Cisterna Chyli: A Meta-Analysis with Surgical Implications. J Clin Med 2024; 13:4285. [PMID: 39124550 PMCID: PMC11313251 DOI: 10.3390/jcm13154285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 08/12/2024] Open
Abstract
Background: The thoracic duct (TD) and the cisterna chyli (CC) exhibit a high degree of variability in their topographical and morphometric properties. Materials and Methods: PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar were searched to identify all studies that included information regarding the morphometric and topographical characteristics of the TD and CC. Results: The most frequent location of the TD termination was the left venous angle, with a pooled prevalence of 45.29% (95% CI: 25.51-65.81%). Moreover, the TD terminated most commonly as a single vessel (pooled prevalence = 78.41%; 95% CI: 70.91-85.09%). However, it divides into two or more terminating branches in approximately a quarter of the cases. The pooled prevalence of the CC was found to be 55.49% (95% CI: 26.79-82.53%). Conclusions: Our meta-analysis reveals significant variability in the anatomy of the TD and CC, particularly regarding TD termination patterns. Despite the predominance of single-vessel terminations, almost a quarter of cases exhibit branching, highlighting the complexity of the anatomy of the TD. These findings demonstrate the importance of detailed anatomical knowledge for surgeons to minimize the risk of accidental injury during head and neck, as well as thoracic surgeries. Our study provides essential insights that can enhance surgical safety and efficacy, ultimately improving patient outcomes.
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Affiliation(s)
- Dawid Plutecki
- Collegium Medicum, Jan Kochanowski University, 25-369 Kielce, Poland
| | - Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College, 33-332 Kraków, Poland
- Youthoria—Youth Research Organization, 30-363 Kraków, Poland
| | - Jakub Wilk
- Department of Anatomy, Jagiellonian University Medical College, 33-332 Kraków, Poland
- Youthoria—Youth Research Organization, 30-363 Kraków, Poland
| | - Sandra Necka
- Department of Anatomy, Jagiellonian University Medical College, 33-332 Kraków, Poland
- Youthoria—Youth Research Organization, 30-363 Kraków, Poland
| | - Miłosz Joniec
- Department of Anatomy, Jagiellonian University Medical College, 33-332 Kraków, Poland
| | - Ahmed Elsaftawy
- Chiroplastica—Lower Silesian Centre of Hand and Aesthetic Surgery, 54-117 Wrocław, Poland
| | - Aleksandra Matuszyk
- Department of Anatomy, Jagiellonian University Medical College, 33-332 Kraków, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, 33-332 Kraków, Poland
- Youthoria—Youth Research Organization, 30-363 Kraków, Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, 33-332 Kraków, Poland
- Youthoria—Youth Research Organization, 30-363 Kraków, Poland
| | - Patryk Ostrowski
- Department of Anatomy, Jagiellonian University Medical College, 33-332 Kraków, Poland
- Youthoria—Youth Research Organization, 30-363 Kraków, Poland
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Moazzam S, O'Hagan LA, Clarke AR, Itkin M, Phillips ARJ, Windsor JA, Mirjalili SA. The cisterna chyli: a systematic review of definition, prevalence, and anatomy. Am J Physiol Heart Circ Physiol 2022; 323:H1010-H1018. [PMID: 36206050 DOI: 10.1152/ajpheart.00375.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The cisterna chyli is a lymphatic structure found at the caudal end of the thoracic duct that receives lymph draining from the abdominal and pelvic viscera and lower limbs. In addition to being an important landmark in retroperitoneal surgery, it is the key gateway for interventional radiology procedures targeting the thoracic duct. A detailed understanding of its anatomy is required to facilitate more accurate intervention, but an exhaustive summary is lacking. A systematic review was conducted, and 49 published human studies met the inclusion criteria. Studies included both healthy volunteers and patients and were not restricted by language or date. The detectability of the cisterna chyli is highly variable, ranging from 1.7 to 98%, depending on the study method and criteria used. Its anatomy is variable in terms of location (vertebral level of T10 to L3), size (ranging 2-32 mm in maximum diameter and 13-80 mm in maximum length), morphology, and tributaries. The size of the cisterna chyli increases in some disease states, though its utility as a marker of disease is uncertain. The anatomy of the cisterna chyli is highly variable, and it appears to increase in size in some disease states. The lack of well-defined criteria for the structure and the wide variation in reported detection rates prevent accurate estimation of its natural prevalence in humans.
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Affiliation(s)
- Sara Moazzam
- School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Lomani A O'Hagan
- School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Alys R Clarke
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Maxim Itkin
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anthony R J Phillips
- Applied Surgery and Metabolism Laboratory, School of Biological Sciences, The University of Auckland, Auckland, New Zealand
| | - John A Windsor
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - S Ali Mirjalili
- Department of Anatomy and Medical Imaging, The University of Auckland, Auckland, New Zealand
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Visible Lymph Affluents in the D3 Volume: An MDCTA Pictorial Essay. Diagnostics (Basel) 2022; 12:diagnostics12102441. [PMID: 36292133 PMCID: PMC9600001 DOI: 10.3390/diagnostics12102441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There seems to be a gap in knowledge of the anatomy of mesenteric lymphatics between the superior mesenteric nodes and the intestinal trunk. To our knowledge, these central lymph vessels were not hitherto systematically searched for, described, or morphometrically analyzed. Our aim was to identify those vessels on the routine multidetector computerized tomography angiography (MDCTA), performed prior to right colectomy for cancer, with extended mesenterectomy, central vascular ligation, and D3 lymphadenectomy. METHODS A total of 420 MDCTA datasets were analyzed utilizing manual segmentation and 3D reconstruction, with the aid of image processing software Osirix, Mimics, and 3-matic. The 3D models and masks underwent a detailed topographic and morphometric analysis. RESULTS Significant vascular-like structures, having neither origin nor termination on the blood vessels, were noted in 18 cases (4.3%) in the D3 volume. The dimensions of visible lymph vessels varied, their mean diameter was 1.81 ± 0.61 mm, and the mean length was 38.07 ± 22.19 mm. In the vast majority of cases, the lymph vessels were situated in front of the superior mesenteric artery (SMA), coursing either longitudinally cranially (13 cases) or transversely/obliquely to the left (5 cases). In all cases but one, the lymph vessel passed at the left-hand side of the middle colic artery. As for the course shape, in seven cases, the lymph vessel appeared highly serpiginous. CONCLUSIONS The regular MDCTA can provide valuable information on mesenteric lymphatics and aid in surgical planning.
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Pieper CC, Feißt A, Meyer C, Luetkens J, Praktiknjo M, Trebicka J, Attenberger U, Jansen C. Impact of transjugular intrahepatic portosystemic shunt creation on the central lymphatic system in liver cirrhosis. Sci Rep 2021; 11:7065. [PMID: 33782430 PMCID: PMC8007746 DOI: 10.1038/s41598-021-86006-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/05/2021] [Indexed: 12/11/2022] Open
Abstract
The puropse of this study was to evaluate associations of cisterna chyli (CCh) diameter with portal hemodynamics and the influence of TIPS-creation in cirrhotic patients. 93 cirrhotic patients (57 male, mean age 59 years) received CT prior to TIPS-creation. 38/93 additionally underwent post-interventional CT. CCh-diameter was measured. After categorization into patients with and without large venous collaterals (i.e. > 6 mm), data were analyzed regarding associations between CCh-diameter, clinical and portal-hemodynamic parameters and diameter-changes after TIPS-creation. Patient survival post-TIPS was analyzed. Median portosystemic pressure-gradient decreased from 20 to 9 mmHg after TIPS-creation. Large venous collaterals were observed in 59 patients. In 69/93 patients (74.2%) the CCh was detectable. Mean pre-interventional diameter was 9.4 ± 2.7 mm (large collaterals: 8.7 ± 2.0 mm, no large collaterals: 10.7 ± 3.2 mm, p = 0.003). CCh-diameter correlated strongly with pre-TIPS portal-pressure (Rs = 0.685, p = 0.0001), moderately with portosystemic-gradient (Rs = 0.524, p = 0.006), liver shear-wave-elastography (Rs = 0.597, p = 0.004) and spleen size (Rs = 0.501, p = 0.01) in patients without large collaterals, but not in patients with large collaterals. Post-TIPS CCh-diameter decreased significantly from 10.2 ± 2.8 mm to 8.3 ± 3.0 mm (p < 0.001). Patients without a detectable CCh on CT survived significantly shorter. The diameter of the CCh is associated with portal-pressure and decreases after TIPS-creation in cirrhotic patients, reflecting a portal decompression mechanism via the lymphatic system. Lack of larger central lymphatics detectable on CT may be associated with shorter survival.
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Affiliation(s)
- Claus Christian Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, Venusberg-Campus 1, 53105, Bonn, Germany.
| | - Andreas Feißt
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, Venusberg-Campus 1, 53105, Bonn, Germany
| | - Carsten Meyer
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, Venusberg-Campus 1, 53105, Bonn, Germany
| | - Julian Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, Venusberg-Campus 1, 53105, Bonn, Germany
| | - Michael Praktiknjo
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg-Campus 1, 53105, Bonn, Germany
| | - Jonel Trebicka
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg-Campus 1, 53105, Bonn, Germany.,European Foundation for the Study of Chronic Liver Failure, Travesera de Gracia 11, 7th Floor, 08021, Barcelona, Spain.,Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Institute for Bioengineering of Catalonia, Barcelona, Spain.,Department of Internal Medicine I, University of Frankfurt, Frankfurt, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, Venusberg-Campus 1, 53105, Bonn, Germany
| | - Christian Jansen
- Department of Internal Medicine I, University Hospital of Bonn, Venusberg-Campus 1, 53105, Bonn, Germany
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