Original ArticleEvaluation of the left neck distal thoracic duct in cirrhosis with computed tomography
Introduction
Thoracic duct is the main and largest collecting vessel of the lymphatic system. The thoracic duct can be associated with various pathological conditions with impaired transportation or excessive production of the lymph [1], [2], [3], [4], [5]. In particular, liver cirrhosis (LC) can enhance the elevation of systemic venous pressure and hepatic lymph production, which may cause a distension of the thoracic duct in the lymphatic system [3], [5].
Visualization of the thoracic duct can be useful to enhance the understanding the underlying systemic disease related to the lymphatic duct dilatation. Most of the lymph formed from the liver leaves via hilar lymphatics and enters the thoracic duct [5], [6]. The thoracic duct shows substantial variability in terms of its course through the mediastinum and the cervical region [7], [8]. However, the thoracic duct drains the lymph from the lower half of the body and the gastrointestinal tract commonly into the large cervical veins. The left distal thoracic duct (DTD) in the left lower neck area has been considered as the end of the thoracic duct [8], [9]. Although most radiological techniques may be limited by hidden course or small diameter of the thoracic duct passing through the mediastinum, prior researchers reported that multidetector row computed tomography (CT) imaging can depict the various appearances of thoracic duct [2], [9].
In practice, the contrast-enhanced chest CT scan can be performed for evaluation of cirrhosis-related intrathoracic disease [10], [11]. The conventional chest CT scan would simultaneously describe the entire thorax, the liver, and the lower neck areas [12]. Prior several studies have reported that a dilated left DTD can mimic an enlarged cervical lymph node like a Virchow's lymph node [13], [14], [15]. To the best of our knowledge, however, the prevalence of the dilated left DTD under the LC has not been studied. Therefore, the purposes of the present study were to assess the visualization and diameter of the left DTD by the contrast-enhanced chest CT examinations depending on the presence of LC and to determine whether the dilatation of the left DTD may be associated with the severity of LC.
Section snippets
Study population
This retrospective review was conducted according to a protocol approved by the institutional review board. In this study, informed consent was not required. Electronic medical records from June 2013 to June 2014 at our institution were searched to identify the patients who had undergone contrast-enhanced chest CT scan for evaluation of cirrhosis-related intrathoracic disease [10], [11]. The following exclusion criteria were applied: (1) patient age < 18 years, (2) past history of major surgery
Results
In 74 (47%) of total 156 subjects, the left DTD was identified by contrast-enhanced chest CT imaging. The frequencies of the identified left DTDs in the control group (n = 55), in the compensated LC group (n = 88), and in the decompensated LC group (n = 13) were 10 (18%), 51 (58%), and 13 (100%), respectively (Fig. 2). The mean diameter of the identified left DTDs in the control, compensated LC, and decompensated LC groups were 3.6 ± 0.8 mm, 3.9 ± 0.5 mm, and 7.3 ± 2.2 mm, respectively (Fig. 3). In comparison
Discussion
The results of the present study demonstrated that the left DTD can be more commonly visualized by contrast-enhanced CT in patients with LC, when compared to the CT findings of the healthy subjects, and the dilation of left DTD may be significantly associated with the severity of LC. Concretely, in the all patients with decompensated LC, the left DTDs were greater than 5 mm in the size and well visualized on the contrast-enhanced chest CT. Generally, it is important for radiologists to be
References (20)
- et al.
Giant cisterna chyli: MRI depiction with gadolinium-DTPA enhancement
Clin Radiol
(2000) - et al.
Morphological features and clinical feasibility of thoracic duct: detection with nonenhanced magnetic resonance imaging at 3.0 T
J Magn Reson Imaging
(2010) - et al.
Thoracic duct and cisterna chyli: evaluation with multidetector row CT
Br J Radiol
(2012) - et al.
Hepatic perivascular lymphedema: CT appearance
AJR Am J Roentgenol
(1988) - et al.
Echo-poor periportal cuffing: ultrasonographic appearance and significance
J Clin Ultrasound
(1993) - et al.
Dilated cisternae chyli: a sign of uncompensated cirrhosis at MR imaging
Abdom Imaging
(2009) - et al.
Computed tomography of the thoracic duct: an anatomic study
Cardiovasc Intervent Radiol
(1981) - et al.
Review of thoracic duct anatomical variations and clinical implications
Clin Anat
(2014) - et al.
Normal CT appearance of the distal thoracic duct
AJR Am J Roentgenol
(2006) - et al.
Cirrhosis-related intrathoracic disease. Imaging features in 1038 patients
Hepato-Gastroenterology
(2005)
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