THE THORACIC DUCT is not often visualized at operation unless specifically exposed. Normally it traverses the diaphragm through the aortic hiatus and courses through the posterior mediastinum. It lies between the aorta and the azygous vein, until at the level of the fifth thoracic vertebra it inclines toward the left, passes behind the aortic arch, and enters the venous system at the junction of the left subclavian and internal jugular veins. However, in the course of various operations for congenital cardiovascular disease we have from time to time noted numerous anatomic variations in the course of the thoracic duct, particularly regarding its relationship to the aortic arch. Specifically, the thoracic duct may lie anterior to the aortic arch and thus may be injured in the course of resection of a coarctation of the aorta or in the division of a patent ductus arteriosus.
The management of a traumatic thoracic duct
Hardy JD, Walker GR, DeGuzman VC. Thoracic Duct Fistula in Infant: Blue Dye Localization and Operative Closure. JAMA. 1962;182(2):187–188. doi:10.1001/jama.1962.03050410083021
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