Many modern surgical procedures involve the area near the distal portion of the thoracic duct, in both the neck and the upper mediastinal area. The distal portion of the duct is the most commonly injured, resulting in either a chylothorax or a chylous fistula unless recognized at the time of injury and repaired. Such injuries have been reported as complications of block dissections in the neck for tuberculous nodes or malignant tumor, scaleniotomy, esophageal resection, the Blalock operation for congenital pulmonary stenosis, radical breast amputation, operation for left-sided torticolis and during left phrenicoexeresis.*
Anatomical studies have indicated that variations occur which may account for some of the injuries.9 Methods used to investigate the variations have included x-ray visualization of the duct18 and cadaver dissections.†
Seventy-five cadavers used for anatomical dissection by the medical students of the University of Tennessee during the years 1950 through 1953 were studied for
GREENFIELD J, GOTTLIEB MI. Variations in the Terminal Portion of the Human Thoracic Duct. AMA Arch Surg. 1956;73(6):955–959. doi:10.1001/archsurg.1956.01280060055012
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