Learning objectives
Majority of chilous leakage are caused to malignancy or iatrogenic trauma,
and only 2.6% of chylothorax has a traumatic non-iatrogenic etiology,
particularly,
blunt chest trauma is a rare cause of chylothorax,
and it is mostly associated with vertebral fracture.
In our paper,
we propose radiological anatomy of chylous structures and patho-phisiological correlation to post-traumatic chylothorax and chyloperitoneum.
Background
Lymphatic draining gut is also known as lacteal,
it appear milk white (FIG.1) due to the presence of fat chylomicrons.
The lymphatic system is anatomically complicated and it is difficult to visualize with current imaging modalities.
Cysterna chyli,
is the abdominal origin of the thoracic duct and is also called "Pequet cisterna",
it receives the bilateral lumbar-lymphatic trunks and it may be recognized on CT scan as a saccular and extended structure (about 5cm),
situated in the retroperitoneum.
This structure is located in the retrocrural...
Imaging findings OR Procedure details
The lymphatic system is anatomically complicated and it is difficult to visualize with current imaging modalities.
Cisterna chyli,
also called “Pequet cisterna” may be recognized on CT scan as a saccular and extended structure (abut 5 cm),
situated in the retroperitoneum,
and it receives the bilateral lumbar lymphatic trunks.
This structure is located in the retrocrural space,
to the right side and behind of the abdominal aorta at the lower border of the T12 or L1-L2 vertebral body.
Literature shows different CT morphologies of cisterna...
Conclusion
Chylotorax and chyloperitoneum are very rare consequences of closed chest and abdominal trauma and correlations are not completely clear,
it could occur after sudden extension of the spine,
or after acceleration-deceleration force to the thorax caused by road accident,
cought or vomiting.
Radiological anatomy of chylous structures is not well evaluable in phisiological condition,
cisterna chyli may be recognized on CT scan as a saccular and extended structure (abut 5 cm),
situated in the retroperitoneum, at the level of the second lumbar vertebra,
where the...
References
M Kiyonaga,
H Mori,S Matsumoto,
Y Yamada,
M Sai,
and F Okada.
Thoracic duct and cisterna chyli: evaluation with multidetector row CT.
The British Journal of Radiology,
85 (2012),
1052–1058
Guermazi A,
Brice P,
Hennequin C,
Sarfati E.
Lymphography: an old technique retains its usefulness.
Radiographics 2003;23:1541–60.
Helmut Schoellnast,
Majid Maybody,
George I.
Getrajdman,
Manjit S.
Bains,
David J.
Finley,
Stephen B.
Solomon.
Computed Tomography-Guided Access to the Cisterna Chyli: Introduction of a Technique for Direct Lymphangiography to Evaluate and Treat Chylothorax.
Cardiovasc Intervent Radiol...