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 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.
It crosses the diaphragm becoming thoracic duct,
the retrocrural space contains also fat,
the Aorta,
the Azygos Vein,
and lymph nodes.
The thoracic duct starts from the cisterna chyli,
at the level of L2-L3, passes through the thorax in the aortic hiatus of the diaphragm.
Chylous reflux in thorax (FIG.2) or abdomen (FIG.3) may develop secondary to damage or obstruction of the thoracic lymphatic vessels or cisterna Chyli,
it is a rare complication of intra-thoracic surgery,
but can be caused also by other types of thoracic duct’s damages or by obstruction in case of malignancies; it could be distinguished in CT scan as low attenuated fluid,
due to chylomicrons from intestinal lymphatic and can be caused by tumors in 55% of the cases,
especially lymphoma,
by trauma in 25%,
by iatrogenic duct’s laceration,
sharp,
blunt trauma or idiopathic reasons.
Rare causes of chylotorax include lymphangioleiomyomatosis and filiariasis.
It has been demonstrated that only 2.6% of chylothorax has a traumatic non-iatrogenic aetiology,
particularly,
blunt chest trauma is a rare cause of chylothorax because of the location of thoracic duct (deep in the mediastinum,
anteriorly to the spine),
and it is mostly associated with vertebral fracture.
The mechanism of thoracic trauma and chylothorax are unknown.
In a paper it was reported a chylothorax after a sudden hyperextension of the spine.
It could occur after an acceleration-deceleration force to the thorax in case of road accident,
or after coughing or vomiting after a meal but the causal mechanisms in the case of an accidental fall are really not known.