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. 2018 Nov;233(5):679-684.
doi: 10.1111/joa.12869. Epub 2018 Aug 12.

A radio-anatomical correlation study of the cisterna chyli

Yohann Renard  1   2   3 , Louis de Mestier  4 , Clémence Balaj  1 , Jean-Michel Arnoux  1 , Marc Labrousse  2 , Gabriela Hossu  3   5 , Manuela Perez  1   3
Affiliations

A radio-anatomical correlation study of the cisterna chyli

Yohann Renard et al. J Anat. 2018 Nov.

Abstract

Surgical laparoscopic procedures in the retroperitoneal and supramesocolic spaces are increasingly frequent. There is a high risk of iatrogenic intraoperative injury of the retroperitoneal lymphatic structures during these procedures. A precise understanding of the anatomy of the thoracic duct (TD) and the cisterna chyli (CC) is essential for safe surgical procedures in this area. However, routine imaging procedures rarely and often incorrectly visualize the CC. The objective of this study was to evaluate the feasibility of a retrograde injection of the TD to fill the CC with a contrast agent in 16 human cadavers. Both magnetic resonance lymphography (MRI) and computed tomography (CT) studies could be performed on the same anatomical specimen, using a contrast medium which hardened, allowing gross dissection. MRI and CT detectability were evaluated, and imaging results were compared with the anatomical dissection. The CC of 12/16 cadavers were successfully injected, and four were unsuccessful due to technical difficulties, showing the effectiveness of the method. This technique can improve understanding of the anatomy of the TD and CC and provides an original option to study the complex anatomy of these structures by correlating precise cadaveric dissections with cross-sectional imaging.

Keywords: cisterna chyli; lymphatic capillaries; thoracic duct.

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Figures

Figure 1
Figure 1
Chest approach of the thoracic duct.
Figure 2
Figure 2
(A) Catheterization of the thoracic duct. (B) Injection through the thoracic duct.
Figure 3
Figure 3
MRI, CT and anatomical (from left to right) results of the cisterna chyli (CC) study in subject number 12. The CC originated from three afferent trunks.
Figure 4
Figure 4
MRI, CT‐scan and anatomical (from left to right) results of the cisterna chyli (CC) study in subject number 15. The CC originated from three afferent trunks.
Figure 5
Figure 5
MRI, CT‐scan and anatomical (from left to right) results of the cisterna chyli (CC) study in subject number 16. The CC originated from two afferent trunks.
Figure 6
Figure 6
Origin of the thoracic duct in subject number 16, without initial dilation and originating from four afferent trunks.
See this image and copyright information in PMC

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