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April 29, 1968

Thoracic Duct Cannulation and Differential Diagnosis of Obstructive Jaundice

Author Affiliations

From the Department of Medicine, Cardiology Division, Washington University School of Medicine, St. Louis (Dr. Witte); Department of Surgery, Washington University at St. Louis City Hospital (Drs. Witte, Cole, and Burton); Department of Pathology, Washington University School of Medicine, and Snodgras Laboratories of St. Louis City Hospital (Dr. Alvarez); and the Department of Surgery, New York University School of Medicine (Dr. Dumont).

JAMA. 1968;204(5):366-370. doi:10.1001/jama.1968.03140180016004

Thoracic duct cannulation was performed prior to exploratory laparotomy in 23 patients with obstructive jaundice caused by diverse factors. High flow of hemorrhagic lymph, usually under increased pressure, distinguished patients with hepatic cirrhosis from those with extrahepatic biliary obstruction and cholangiolitic hepatitis. Very low flows were observed only in patients with widespread malignancy involving the extrahepatic biliary tract. Information concerning the flow, pressure, and composition of thoracic duct lymph is helpful in understanding and distinguishing whether obstructive jaundice arises from a stone in the common bile duct, metastatic cancer, the use of a cholestatic drug, or excessive intake of alcohol.