Biometric measurements involving the terminal portion of the thoracic duct on left cervical level IV: an anatomic study

Abstract

To determine the point of entrance of the thoracic duct in the venous system, as well as to evaluate some biometric measurements concerning its terminal portion, we conducted an anatomic study on 25 non-preserved cadavers. The termination of the thoracic duct occurred on the confluence between the left internal jugular vein and the left subclavian vein in 60 % of the individuals. The average results for the biometric measurements were: distance between the end of left internal jugular vein and omohyoid muscle 31.2 ± 2.7 mm; distance between the end of thoracic duct and the left internal jugular vein 0.0 ± 0.0 mm; distance between the end of thoracic duct and the left subclavian vein 3.6 ± 1.0 mm; distance between the end of thoracic duct and the left brachiocephalic vein 10.7 ± 3.1 mm. Moreover, it was identified that the left internal jugular vein length in level IV, measured between its entrance in the left subclavian vein and the omohyoid muscle, was able to predict the termination of the thoracic duct on the junction between the left internal jugular vein and the left subclavian vein (OR = 2.99) with high accuracy (79.3 %). In addition, the left internal jugular vein length at level IV was able to predict the localization of thoracic duct termination. Thus, this finding has practical value in minimizing the risk for a potential chyle leak during or after a left-sided neck dissection.

Anatomical variations in distal portion of the thoracic duct—A systematic review

“…The TD can therefore terminate into the venous system either as single or multiple channels. A single‐entry point was found in all the cases in two studies (Peña and Zuñiga, ; Louzada et al, ). Other authors found a single‐entry point in more than 70% of cases, excluding Kaur et al (), Shimada and Sato (), and Correia (), who found most cases with multiple entry points.…”

“…According to the QUACS score, the study with the highest methodological quality and reliability was that of Peña et al with 11 points (2009), followed by Louzada et al (), Langford et al (), Davis et al (1914), Correria et al (1925), and Akcali et al with 9 points each (2006). The study with the lowest score of 5 was by Parsons ().…”

“…Unfortunately, descriptions in classic textbooks are rather schematic and do not necessarily correspond to the situations in patients (Rouvière, ; Kinnaert, ). Several studies on different populations have examined the anatomy of the TD, and more particularly, its cervical termination to answer the question about interindividual variations (Parsons, ; Louzada et al, ). A review has already been conducted before, but it is not exhaustive for the cervical termination of the TD (Phang et al, ).…”

“…The distal portion of the TD is most commonly injured, resulting in either a chylothorax or a chylous fistula unless recognized at the time of injury and repaired (Gottlieb and Greenfield, ). During a neck dissection involving the cervical level on the left side, there is a risk of injury of the TD at its final segment, before entering the venous system (Louzada et al, ). It should be suspected in neck surgery for pulmonary and esophageal malignancies (Langford et al, ; Riquet et al, ), anterior spinal procedures (Akcali et al, ), in the case of pediatric thoracic surgery, and in the rare condition of aortic arch malformation (Shirakawa et al, ).…”

Quantitative analysis of lymph nodes in neck dissection specimens. Morphologic study

“…Accordingly, as the measure of the distance between this muscle and the clavicle is quite variable, it may influence on the amount of LNs recovered at this level 19 . However, studies directed to this anatomical region 19,21 found no significant differences in measures of these distances related to sex, age and height. The number of LNs on level V had positive correlation with weight and BMI of individuals, confirming findings of a previous study of lymph node content in patients undergoing ND diagnosed with melanoma 22 .…”