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Pathogenesis of bilateral chylothorax after injury of thoracic duct during central venous catheterization.

Ray A - Lung India (2015 Nov-Dec)

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Critical Care and Sleep Medicine, Fortis Flt. Lt. Rajan Dhall Hospital, Vasantkunj, New Delhi, India E-mail: doctoranimeshray@gmail.com.

AUTOMATICALLY GENERATED EXCERPT
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How can that be explained? Contemporary literature also does not elaborate on to the reason for the same... However, it appears based on reports of injury to lymphatic ducts (albeit in different scenarios such as thoracic duct ligation) that accumulation of chyle bilaterally due to unilateral injury to the thoracic duct may be due to the following reasons: The leaking chyle sips into the mediastinum probably tracking along the bronchovascular structures Following injury to the thoracic duct, there may be occlusion or near-occlusion of the lumen of the thoracic duct (as seen in cases of ligation of the thoracic duct)... Now the increasing hydrostatic pressure within the thoracic duct proximal to the occluding site, along with the intrapleural negativity (the pleural space being adjacent to the mediastinum), leads to the transudation of chyle into the mediastinal space [Figure 2]... Following collection into the mediastinum, the chyle flows into the pleural spaces in the following ways: Rupture of the mediastinal pleura due to accumulation of chyle under tension in the mediastinum Sipping into the pleural spaces by maceration or backflow through intrapulmonary lymphatics Suction of chyle into the pleural spaces by the intrapleural negativity Is it due to the preferential passage of chyle from the mediastinal space to a particular pleural space owing to pressure differences in the pleural spaces? Animal studies have shown that there may be significant differences in the right and left pleural space pressures... A review of the anatomy of the thoracic duct reveals that this may be due to the collection of chyle above the suprapleural membrane or Sibson's fascia... Sibson's fascia extends from the inner border of the first rib to cover the thoracic inlet... The thoracic duct and the right lymphatic duct traverse the Sibsons's fascia of the left side and the right side, respectively, before emptying into the systemic circulation... Injury to the thoracic duct will lead to collection of chyle limited below by the Sibson's fascia and hence, will result in a swelling in the supraclavicular fossa [Figure 3].

No MeSH data available.


Related in: MedlinePlus

Cartoon of the mechanisms due to which chylothorax occurs after injury to the right lymphatic duct/thoracic duct
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Related In: Results  -  Collection

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Figure 2: Cartoon of the mechanisms due to which chylothorax occurs after injury to the right lymphatic duct/thoracic duct

Mentions: Following injury to the thoracic duct, there may be occlusion or near-occlusion of the lumen of the thoracic duct (as seen in cases of ligation of the thoracic duct). Now the increasing hydrostatic pressure within the thoracic duct proximal to the occluding site, along with the intrapleural negativity (the pleural space being adjacent to the mediastinum), leads to the transudation of chyle[3] into the mediastinal space [Figure 2].


Pathogenesis of bilateral chylothorax after injury of thoracic duct during central venous catheterization.

Ray A - Lung India (2015 Nov-Dec)

Cartoon of the mechanisms due to which chylothorax occurs after injury to the right lymphatic duct/thoracic duct
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663892&req=5

Figure 2: Cartoon of the mechanisms due to which chylothorax occurs after injury to the right lymphatic duct/thoracic duct
Mentions: Following injury to the thoracic duct, there may be occlusion or near-occlusion of the lumen of the thoracic duct (as seen in cases of ligation of the thoracic duct). Now the increasing hydrostatic pressure within the thoracic duct proximal to the occluding site, along with the intrapleural negativity (the pleural space being adjacent to the mediastinum), leads to the transudation of chyle[3] into the mediastinal space [Figure 2].

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Critical Care and Sleep Medicine, Fortis Flt. Lt. Rajan Dhall Hospital, Vasantkunj, New Delhi, India E-mail: doctoranimeshray@gmail.com.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

How can that be explained? Contemporary literature also does not elaborate on to the reason for the same... However, it appears based on reports of injury to lymphatic ducts (albeit in different scenarios such as thoracic duct ligation) that accumulation of chyle bilaterally due to unilateral injury to the thoracic duct may be due to the following reasons: The leaking chyle sips into the mediastinum probably tracking along the bronchovascular structures Following injury to the thoracic duct, there may be occlusion or near-occlusion of the lumen of the thoracic duct (as seen in cases of ligation of the thoracic duct)... Now the increasing hydrostatic pressure within the thoracic duct proximal to the occluding site, along with the intrapleural negativity (the pleural space being adjacent to the mediastinum), leads to the transudation of chyle into the mediastinal space [Figure 2]... Following collection into the mediastinum, the chyle flows into the pleural spaces in the following ways: Rupture of the mediastinal pleura due to accumulation of chyle under tension in the mediastinum Sipping into the pleural spaces by maceration or backflow through intrapulmonary lymphatics Suction of chyle into the pleural spaces by the intrapleural negativity Is it due to the preferential passage of chyle from the mediastinal space to a particular pleural space owing to pressure differences in the pleural spaces? Animal studies have shown that there may be significant differences in the right and left pleural space pressures... A review of the anatomy of the thoracic duct reveals that this may be due to the collection of chyle above the suprapleural membrane or Sibson's fascia... Sibson's fascia extends from the inner border of the first rib to cover the thoracic inlet... The thoracic duct and the right lymphatic duct traverse the Sibsons's fascia of the left side and the right side, respectively, before emptying into the systemic circulation... Injury to the thoracic duct will lead to collection of chyle limited below by the Sibson's fascia and hence, will result in a swelling in the supraclavicular fossa [Figure 3].

No MeSH data available.


Related in: MedlinePlus