Chylous fluid is rarely found within the serous cavities. This accumulation of fluid may be caused by obstruction or injury of any portion of the thoracic duct. Although the thoracic duct is usually a single structure that empties into the left subclavian vein, it is variable both in structure and venous termination. It may consist of multiple trunks in the thorax with cross communications; it may have multiple venous terminations in left or right subclavian, internal or external jugular, innominate, vertebral, or azygos veins. There may be communications with iliac or lumbar veins, vena cava inferior, or left renal vein. With complete obstruction of the thoracic duct, intraductal pressure increases and distal lymphatics dilate and rupture, producing chylous effusions if no collateral channels exist. If obstruction occurs slowly, collaterals may develop sufficiently to prevent chylous effusions.
Yater1 studied 24 cases of thoracic duct obstruction from various causes; only three
Palken M, Weller RW. CHYLOTHORAX AND CHYLOPERITONEUM: REPORT OF A CASE OCCURRING AFTER EMBOLISM OF LEFT SUBCLAVIAN VEIN WITH THORACIC DUCT OBSTRUCTION. JAMA. 1951;147(6):566–568. doi:10.1001/jama.1951.73670230003008a
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