Review the typical embryology and anatomy of the thoracic duct. Describe and illustrate,
usingboth schematic diagrams and lymphangiography,
variations in thoracic duct anatomy. Discuss technical and procedural modifications for successful embolization in the face of challenging anatomic variants.
Chylous leakagesmay be the result of numerous etiologies including injury to the thoracic duct from cardiothoracic surgeries,
or idiopathic causes.
Such injuries maypresent as chylous pleural effusions,
and postoperative chylous wound leaks [1,2,3].
Persistent high output chylothoraces havesignificant mortality rates,
as high as 25-50%,
due to the loss of plasma proteins,
Findings and procedure details
Embryology of the Thoracic Duct [4,5,6] Lymphatic system develops at the end of the sixth week of life. Lymphatic vessels form similar to blood vessels as they are derived from hemangioblastic stem cells. Lymphatic clefts andsacs form around large embryologic veins and develop as evaginations from the venous system. Lymphatic clefts eventually form extensive plexuses between each other and fuse to form larger vessels including the embryonic right and left thoracic ducts. Formation of lymph...
The thoracic duct may be injured in a variety of intrathoracic surgeries thereby necessitating embolization procedures. Variations in thoracic duct anatomy,
from the location or presence/absence of the cisterna chyli to the intrathoraic course of the thoracic duct,
provide challenges to interventional radiologists during embolization. Knowledge of thoracic duct embryology and anatomy,
supplemented with extensive imaging correlation,
allows successful treatment with minimal morbidity and...
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please do not hesitate to contact us. Nikunj Rashmikant Chauhan,
MD PGY V Department of Radiology Brigham and Women's Hospital Harvard Medical School firstname.lastname@example.org Jeffrey Forris Beecham Chick,
MPH PGY V Department of Radiology Brigham and Women's Hospital Harvard Medical School email@example.com Alisa Siziki Han,
MD Instructor of Radiology Brigham and Women's Hospital Harvard Medical School firstname.lastname@example.org Special thanks...
 Campagna J and Jain R.
“Thoracic Duct Embolization.” Transcatheter Embolization and Therapy.
Ed David Kessel and Charles Ray.
471-472.  Chen E and Itkin M.
Thoraic Duct Embolization for Chylous Leaks.
Semin Interven Radiol.
2011;28:63-74.  Cope,
Management of chylothorax via percutaneous embolization.
Curr Opin Pulm Med.
2004; 10:311–314.  Pamarthi V,
Suzuki Han A,