Thoracic Duct

LYMPHATIC SYSTEM • Lymph vessels Lymph capillaries Lymph vessels proper- veins Terminal lymph ducts Thoracic duct Right Lymphatic duct

B. Lymphoid tissue Primary lymphatic follicle Lymph nodes Haemolymph nodes-Spleen Thymus

Lymphatic System

Lymphoid Tissues

THORACIC DUCT LONGEST LYMPH TRUNK

Drains whole body except Rt side of H&N Rt.UL Rt.Chest wall Rt.Lung &Pleura Rt.surface of Heart &PC Rt.dome of diaphragm Rt.surface of liver

Length: 40-45CMS Caliber: 0.5 cms Extent: Beginning – T12 Termination- C7 Appearance: Beaded Valves: Several Pressure related

one constant at termination

Course: Cervical Thoracic Abdominal

RELATIONS: Abdominal part Aortic Opening-T12 Anterior: Median arcuate ligament Posterior:T12 Right: Azygos vein Left: Aorta

Rt .

Lt

At Aortic Opening Posterior:T12

Right: Azygos vein

Left: Aorta

Azygos

Aorta

Thoracic duct Aortic opening Post. Mediastinum Sup.Mediastinum

RELATIONS: PosteriorMediastinum

Anterior: Rt. Pleural recess Oesophagus Diaphragm

Posterior Mediastinum contd…

Posterior: •T5 - T 12 Vertebrae •Post.Intercostal vessels (Rt) •Azygos & Hemiazygos communications

Posterior Mediastinum Contd….. Right-

Right: •Azygos V •Splanchnic nerves (Rt) •Sympathetic trunk (Rt) •Lung and Pleura (Rt)

Posterior Mediastinum Contd…..

Left: •Thoracic aorta •Hemiazygos Vs •Splanchnic nerves (Lt)

RELATIONS: SuperiorMediastinum

Anterior: •Lt lung & pleura Arch of aorta (Lower) •Lt.Subclavian A (Upper) •Thymus

Sup.Mediastinum Contd….

Posterior: •T1-T4 Vertebrae •Longus cervicis

SuperiorMediastinum contd… Right:

•oesophagus Left:

Lt.Lung & Pleura (Mediastinal surface)

RELATIONS: Cervical Anterior: Carotid sheath

Cervical PosteriorMedial •Vertebral A (Lt) •Vertebral V (Lt) •Inf. Cervical ganglion (Lt) •C7 TP(Lt)

Posterior Lateral: •Subclavian A – 1st part (Lt) •Thyrocervical trunk (Lt) & its branches •Scalenus anterior (Lt) & fascia •Phrenic N (Lt)

Relations: Cervical Subclavian A.&V Vertebral A. Thyrocervical Trunk TD crossing Subclavian A.

Thoracic duct Termination

Variations in termination And in course Division in neck Division in thorax

Factors responsible for propulsion of lymph through Thoracic duct •Pressure changes in thorax •Aortic pulsations •Valves •Muscle contraction- Cisterna chyli •Raised abdominal pressure

Tributaries Lt. Jugular lymph trunk Lt Subclavian lymph trunk Lt. Bronchomediastinal lymph trunk Efferents from Post.intercostal L.nodes Upper 5 spaces on Lt Lower 6 ICS – Pair of descending lymph trunks Pair of Ascending Lumbar lymph trunks

DEVELOPMENT OF THORACIC DUCT Primitive Right and left lymphatic ducts 1.Lower Vertical 2.Intermediate oblique 3.Upper part

APPLIED ANATOMY 1.Lymphangiography 2. Injury during oesophageal surgery 0.2-3.0% 3. Rupture of thoracic duct – Fracture of thoracic vertebrae – chylothorax -Progressive immune and nutritional deficit 4.Thoracic duct obstruction – Filarial parasitecollection of chylous fluid in pleura, peritoneum,scrotal sac or chyluria 5. Inadvertent incision or transection of duct during thoracoscopic surgery