A patient who has suffered severe chest trauma in an automobile accident is found to have fluid in the right pleural space. A thoracentesis reveals the presence of chylous fluid in the pleural space, suggesting a rupture of the thoracic duct. In which regions of the thorax is the thoracic duct found.
Posterior and superior mediastinum o Thoracic duct is the main lymphatic channel of the body that drains to the venous system from the body except the: -Right thorax -Right arm -Right head and neck o It begins as a continuation of the cisterna chyli at the level of the T 12 veebras. It passes to the right of the aoa through the aoic hiatus. It then ascends to the right of the oesophagus with the azygous vein on its left. Posteriorly are the right posterior intercostal aeries. o At the level of the fifth thoracic veebra the duct passes superiorly and to the left, posterior to the oesophagus (posterior mediastinum). It then ascends on the left side of the oesophagus into the superior mediastinum. At this point, the aoa lies anteriorly and posteriorly is the anterior longitudinal ligament of the veebral bodies. o Superiorly, within the neck the thoracic duct passes laterally to arch over the dome of the right pleura. It passes laterally and posterior to the carotid sheath and anterior to the veebral aeries. During this final section: o It can divide into 2-3 branches o It is joined by lymphatic trunks from: o The left side of the head - the jugular trunk o The left arm - the left subclan trunk o All the branches merge with the subclan vein, the internal jugular vein or the left brachiocephalic vein near the intersection of all three o On route, the thoracic duct receives lymphatic efferents from: -Intercostal nodes -Anterolateral and -posterior mediastinal nodes -Tracheobronchial nodes
Anterior and middle mediastinum
Anterior and superior mediastinum
Middle and superior mediastinum
Posterior and superior mediastinum