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Kanavaros P, Karatzias G, Papoudou-Bai A, Barbouti A, Troupis T. The right lymphatic duct: basic anatomy and clinical relevance. VASA 2024. [PMID: 39206618 DOI: 10.1024/0301-1526/a001146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
The anatomical variability of the thoracic duct and the right lymphatic duct predisposes them to inadvertent damage following head and neck surgery thereby leading to chyle leak which is an uncommon complication with potentially significant associated morbidity. Although chyle leak is predominately associated with left-sided neck surgery, it also occurs as a complication of the right-sided neck dissection. Variable figures concerning chyle leakage after right-sided neck dissections were reported, ranging from 0 per cent to higher prevalences such as 14%, 24%, 33% and 60% of total cases of chyle leakages associated with neck surgery. The right-sided complications may implicate the right lymphatic duct and right-sided terminations of the thoracic duct into the venous system which occur in about 1-6% of humans. Other clinically relevant conditions involving the right-sided major lymphatic vessels include chyle leaks following right anterior cervical spine surgery, cysts of the right lymphatic duct and dilatation of the right lymphatic duct in the setting of recurrent cervical swelling. This article presents a review of the literature concerning the basic anatomy and the clinical relevance of the right lymphatic duct and the right-sided terminations of the thoracic duct into the venous circulation.
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Affiliation(s)
- Panagiotis Kanavaros
- Faculty of Medicine, Department of Anatomy-Histology-Embryology, School of Health Sciences, University of Ioannina, Greece
- Faculty of Medicine, Department of Anatomy, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | | | - Alexandra Papoudou-Bai
- Faculty of Medicine, Department of Pathology, School of Health Sciences, University of Ioannina, Greece
| | - Alexandra Barbouti
- Faculty of Medicine, Department of Anatomy-Histology-Embryology, School of Health Sciences, University of Ioannina, Greece
| | - Theodoros Troupis
- Faculty of Medicine, Department of Anatomy, School of Health Sciences, National and Kapodistrian University of Athens, Greece
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2
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Muacevic A, Adler JR, Niermeyer W, Joshi A. The Use of Ethanol Sclerotherapy To Treat a Large Cervical Lymphocele. Cureus 2022; 14:e33043. [PMID: 36721545 PMCID: PMC9881499 DOI: 10.7759/cureus.33043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 12/29/2022] Open
Abstract
Cervical lymphoceles are atypical lymphatic accumulations that develop within the subcutaneous tissue of the neck. While these accumulations have traditionally been removed via surgical excision, sclerotherapy has recently emerged as a reasonable option to prevent injury to surrounding vascular, neurologic, and pulmonary structures. The purpose of this case report is to describe the efficacy of ethanol sclerotherapy for a cervical lymphocele refractory to surgical embolization. We present the case of a 70-year-old male with a large cervical lymphocele that was initially treated with surgical embolization. The mass rapidly reaccumulated within two weeks and the patient subsequently underwent ethanol sclerotherapy with no evidence of re-accumulation after 18 months. This case highlights the utility of ethanol due to its better side-effect profile, widespread availability, and cheaper cost when compared to better-described agents.
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Amirtharaja A, Quek JZ, Battison S, Srinivasan B. Cervical thoracic duct cyst: a conservative resolution. BMJ Case Rep 2022; 15:e250554. [PMID: 36261221 PMCID: PMC9582293 DOI: 10.1136/bcr-2022-250554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
A woman in her 70s presented with an enlarging, asymptomatic palpable mass in the left supraclavicular fossa. The clinical impression was of a lipoma. Imaging showed a cystic lesion with continuity of a tubular structure leading to the carotid sheath. Cytology was consistent with thoracic duct sampling. A diagnosis of the rare entity of a thoracic duct cyst with supraclavicular extension was made. This was managed conservatively via repeated aspirations which reduced the size of the mass.
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Affiliation(s)
- Aimee Amirtharaja
- Oral and Maxillofacial Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | | | - Sobana Battison
- Department of Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Yu H, Mao Q, Zhou L, Li J, Xu X. Rare Case of Cystic Lymphangioma Transforming Into Lymphangiosarcoma: A Case Report. Front Oncol 2022; 12:814023. [PMID: 35251984 PMCID: PMC8894725 DOI: 10.3389/fonc.2022.814023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/26/2022] [Indexed: 12/15/2022] Open
Abstract
Cystic lymphangioma (CL) is a rare benign tumor that mainly occurs in the neck and axilla and usually occurs in children, whereas lymphangiosarcoma (LAS) is a rare invasive tumor, usually secondary to chronic lymphedema caused by various causes, with a rare malignant transformation from CL. We presented the case of a 63-year-old woman who underwent four surgical excisions for multiple recurrence of CL in the right groin. The changes of imaging and pathological examination revealed the unusual process of its gradual malignant transformation into LAS. We followed up the patient for 16 years, and she eventually died of LAS complications.
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Affiliation(s)
- Huili Yu
- Department of Radiology, China Resources & WISCO General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Qinxiang Mao
- Department of Radiology, Liuzhou People’s Hospital, Liuzhou, China
| | - Lingyan Zhou
- Department of Radiology, The Second Hospital of Wuhan Iron and Steel Company, Wuhan, China
| | - Jiawei Li
- Department of Radiology, China Resources & WISCO General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Xunhua Xu
- Department of Radiology, China Resources & WISCO General Hospital, Wuhan University of Science and Technology, Wuhan, China
- *Correspondence: Xunhua Xu,
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Chasen NN, Wang JR, Gan Q, Ahmed S. Imaging of Cervical Lymph Nodes in Thyroid Cancer: Ultrasound and Computed Tomography. Neuroimaging Clin N Am 2021; 31:313-326. [PMID: 34243866 DOI: 10.1016/j.nic.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Sonographic evaluation of cervical lymph nodes in patients with thyroid malignancy is important both for preoperative staging and for post-treatment surveillance, and contrast-enhanced computed tomography plays a complementary role. Knowledge of anatomy and surgical approaches, combined with an understanding of the various imaging features that distinguish malignant from benign lymph nodes, allows for accurate staging, thereby enabling complete surgical initial resection.
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Affiliation(s)
- Noah Nathan Chasen
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1482, Houston, TX 77030-4009, USA
| | - Jennifer Rui Wang
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX 77030-4009, USA
| | - Qiong Gan
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 0085, Houston, TX 77030-4009, USA
| | - Salmaan Ahmed
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1482, Houston, TX 77030-4009, USA.
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Hauer L, Gencur J, Posta P, Kasl Z, Rusnak S, Skalova A, Chalupova M, Liska J, Merglova V. Cervical lymphocele: A rare complication following salvage surgery for ocular adnexal apocrine adenocarcinoma. A case report and review of the literature. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 166:117-125. [PMID: 33252115 DOI: 10.5507/bp.2020.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/22/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND An ocular adnexal apocrine adenocarcinoma (OAAA) is an extremely rare, but potentially aggressive and life-threatening tumor with ill-defined management based only on recommendations from a limited number of reported cases. The development of cervical lymphocele following neck dissection is a very rare complication, but one with well established methods for prevention and treatment. Here we describe a previously unreported case of salvage surgery including neck dissection for OAAA in addition to an emergence of cervical lymphocele. A literature review of current knowledge on both pathological conditions is included. METHODS AND RESULTS A 58-year-old man suffering from OAAA, previously treated with multiple eye-sparing excisions and adjuvant proton therapy, underwent salvage surgery for locoregional recurrence of the tumor. A partial orbitectomy with orbital exenteration, primary reconstruction and left-sided neck dissection was performed. The procedure was complicated by a cervical lymphocele resolved after the surgical therapy. The patient remained disease-free during the one-year follow-up. CONCLUSION OAAA is a locally aggressive tumor with potential to local or distant metastatic spread. Whole-body staging, regular clinico-radiological follow-up and stage-dependent therapy with surgery as the first-choice treatment is required. A cervical lymphocele as a complication of especially left-sided neck dissection is managed with a conservative or surgical therapy according to the level of lymph leakage, extent and localization of lesions, presence of local or systemic disorders and the period from primary surgery.
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Affiliation(s)
- Lukas Hauer
- Department of Dentistry, University Hospital and Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic
| | - Jiri Gencur
- Department of Dentistry, University Hospital and Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic
| | - Petr Posta
- Department of Dentistry, University Hospital and Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic
| | - Zdenek Kasl
- Clinic of Ophthalmology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic
| | - Stepan Rusnak
- Clinic of Ophthalmology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic
| | - Alena Skalova
- Sikl's Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Ed. Benese 13, 30599, Pilsen, Czech Republic
| | - Miroslava Chalupova
- Department of Dentistry, University Hospital and Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic
| | - Jan Liska
- Department of Dentistry, University Hospital and Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic
| | - Vlasta Merglova
- Department of Dentistry, University Hospital and Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic
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Pieper CC. Nodal and Pedal MR Lymphangiography of the Central Lymphatic System: Techniques and Applications. Semin Intervent Radiol 2020; 37:250-262. [PMID: 32773950 DOI: 10.1055/s-0040-1713442] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Novel lymphatic imaging and interventional techniques are increasingly used in the diagnostic workup and treatment of pathologies of the central lymphatic system and have opened a new field of interventional radiology. The mainstay of lymphatic imaging today is magnetic resonance lymphangiography (MRL). It provides information on the anatomy of the central lymphatic system, lymphatic flow, as well as lymphatic pathologies and therefore is a valuable tool for treatment planning. There are two techniques to perform contrast-enhanced MRL: nodal dynamic contrast-enhanced MRL (nodal DCE-MRL) and interstitial transpedal MRL (tMRL). Nodal DCE-MRL yields superior information on lymphatic flow dynamics and is therefore best suited for suspected lymphatic flow pathologies and lymphatic malformations. tMRL is a technically simpler alternative for central lymphatic visualization without the need for sonographically guided lymph node cannulation. This review article describes current MRL techniques with a focus on contrast-enhanced MRL, their specific advantages, and possible clinical applications in patients suffering from pathologies of the central lymphatic system.
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Affiliation(s)
- Claus Christian Pieper
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Bonn, Bonn, Germany
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Girl With a Sudden Lump in the Neck. Ann Emerg Med 2020; 75:e23-e24. [PMID: 32216897 DOI: 10.1016/j.annemergmed.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Indexed: 11/20/2022]
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9
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Cyst of the right lymphatic duct. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:123-125. [DOI: 10.1016/j.anorl.2019.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/01/2019] [Accepted: 01/16/2019] [Indexed: 11/19/2022]
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Pamarthi V, Pabon-Ramos WM, Marnell V, Hurwitz LM. MRI of the Central Lymphatic System: Indications, Imaging Technique, and Pre-Procedural Planning. Top Magn Reson Imaging 2017; 26:175-180. [PMID: 28665889 PMCID: PMC5548502 DOI: 10.1097/rmr.0000000000000130] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Magnetic resonance imaging is increasingly being used to evaluate the lymphatic system. Advances in magnetic resonance (MR) software and hardware allow improved visualization of lymph nodes and lymphatic vessels. We describe how MR lymphangiography can be used to diagnose central lymphatic system anatomy and pathology, which can be used for diagnostic purposes or for pre-procedural planning.
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Dortch JD, Eck D, Hakaim AG, Casler JD. Management of cervical thoracic duct cyst with cyst-venous anastomosis. Int J Surg Case Rep 2014; 5:1028-30. [PMID: 25460465 PMCID: PMC4275970 DOI: 10.1016/j.ijscr.2014.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/12/2014] [Accepted: 10/08/2014] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Cervical thoracic duct cyst (CTDC) is a rare cause of lateral neck mass. Surgical excision with ligation of the cervical thoracic duct is the current standard for definitive management with symptomatic patients. We report the first case of an alternative method of management performing a cyst venous anastomosis for decompression. PRESENTATION OF CASE A 77 year old female presented with a six month history of left arm pain, swelling and a left-sided cystic neck mass. She was treated with cyst-venous anastomosis between the cyst wall and the left internal jugular vein. At two year follow-up, she has had resolution of pain and no recurrence of the mass. DISCUSSION Many potential etiologies have been proposed for CTDC, though surgical management of this rare problem has consistently required cyst excision and thoracic duct ligation. Few innovative modes of therapy have been developed to address this problem in a less invasive manor. Maintaining a more natural thoracic duct anatomy decreases the likely of complications associated with duct ligation. CONCLUSION Cyst-venous anastomosis for the management of CTDC provides an effective, novel form of treatment which maintains the integrity of the thoracic duct and avoids potential complications associated with duct ligation.
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Affiliation(s)
- John D Dortch
- Department of Surgery, Mayo Clinic, Jacksonville, FL, United States.
| | - Dustin Eck
- Department of Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Albert G Hakaim
- Department of Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - John D Casler
- Department of Otorhinolaryngology, Mayo Clinic, Jacksonville, FL, United States
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12
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Kim JH. Ultrasound-guided sclerotherapy for benign non-thyroid cystic mass in the neck. Ultrasonography 2014; 33:83-90. [PMID: 24936500 PMCID: PMC4058977 DOI: 10.14366/usg.13026] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 01/28/2014] [Indexed: 11/03/2022] Open
Abstract
Surgical excision has traditionally been the treatment of choice for benign non-thyroid cystic neck masses, including lymphatic malformation, ranula, branchial cleft cyst, thyroglossal duct cyst, and parathyroid cyst. However, there is a tendency toward recurrence after surgery, and surgery may be accompanied by complications, including nerve injuries, vascular injuries, and scar formation. Ultrasound-guided sclerotherapy using various agents has been challenged and successfully applied as an alternative treatment for benign non-thyroid cystic neck masses. This report reviews the available sclerosing agents and describes the applications of sclerotherapy to the treatment of benign cystic masses in the neck.
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Affiliation(s)
- Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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13
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Blei F. Update March 2012. Lymphat Res Biol 2012. [DOI: 10.1089/lrb.2012.1012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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