Lymphatics: Thoracic Duct and Cysterna Chyli

Lizars, John. A system of anatomical plates of the human body. Lymphatics of the head and neck. Published in Edinburgh about 1840.

The right lymphatic duct forms various combinations with the right subclavian vein and jugular trunks. It is rare to find a simple right lymphatic duct that enters directly into the junction of the internal jugular and subclavian veins.

The thoracic duct, which drains most of the body, may end by joining the left internal jugular, the junction of the left internal jugular and left subclavian vein, or the brachiocephalic vein.

It is common for the duct to have several terminal divisions; it might be doubled or even tripled over a variable distance.

When doubled, it can open on both the right and left sides, at the venous angle.

Persistence of paired ducts has been reported in cases of doubled aortic arch and in low origin (from the descending aorta) of the right subclavian.

Persistence of the (embryonic) right duct, with obliteration of the usual left duct, has been noted in a case of right aortic arch of the type presenting a left brachiocephalic trunk.

The size shape, and location of the cysterna chyli is extremely variable; the structure is absent in about 50% of cases examined.

The thoracic duct has been found in a normal subject, without other vascular variation, to terminate on the right side at the junction of the right subclavian and internal jugular veins.

The thoracic duct has also been found draining into the azygos vein and the inferior vena cava.

In one study, the thoracic duct opened into the following vessels (in order of decreasing frequency): a) left venous angle, b) internal jugular, c) left subclavian, d) vertebral, and e) others, including the azygos, hemiazygos and brachiocephalic. The thoracic duct has also been found draining into the subclavian artery.

A thoracic duct was found lying entirely to the left of the mid-vertebral line.

The length of the thoracic duct varies from 38 to 45 cm in the adult.

It usually begins at at the vertebral level of L2 but can begin at L3, L1, or even T12.

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