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Clinical Problem Solving: Radiology
June 21, 2010

Radiology Quiz Case 1: Diagnosis

Author Affiliations
 

C. DOUGLASPHILLIPSMD

Arch Otolaryngol Head Neck Surg. 2010;136(6):632. doi:10.1001/archoto.2010.76-b

Diagnosis: Cervical thoracic duct cyst

The thoracic duct transmits most of the lymph and chyle into the blood. It is the common trunk of all the lymphatic vessels of the body, except those on the right side of the head, neck, and thorax; the right upper extremity; the right lung; the right side of the heart; and the convex surface of the liver. It originates in the abdomen on the right side of the aorta and on the front of the body of the second lumbar vertebra, enters the thorax through the aortic hiatus of the diaphragm, and ascends through the mediastinum between the left side of the aorta and the azygos vein. As it passes into the neck, it forms an arch that rises about 3 to 4 cm above the clavicle and crosses anterior to the subclavian artery, vertebral artery and vein, thyrocervical trunk, and phrenic nerve. It eventually joins the venous system at the junction of the left subclavian vein with the left internal jugular vein.1

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