Right thoracic duct. The structure and function of the thoracic lymphatic duct

thoracic duct I Thoracic duct (ductus throracicus)

the main lymphatic collector that collects lymph from most of the human body and flows into the venous system. Passes G. p. only, flowing from the right half of the chest, head, neck and right upper limb - it flows into the right.

The length of G. p. in an adult is about 40 cm, diameter about 3 mm. The duct is formed in the retroperitoneal tissue at the level of THXII - L II vertebrae by the fusion of large lymphatic trunks. The initial part of the duct () is wide - with a diameter of 7-8 mm. G. p. passes through the diaphragm in the back and is located between the descending aorta and the unpaired vein. Then G. p . deviates to the left and the aortic arch emerges from under the left edge of the esophagus, slightly above the left clavicle, curves in an arcuate manner and flows into the venous bed at the confluence of the left subclavian and internal jugular veins. In the thoracic duct, incl. at its confluence with the venous system, there are valves that prevent blood from flowing into it.

The main research method of G. p. is contrast lymphography . It is carried out by slowly introducing superfluid iodo-lipol or myodil into the lymphatic vessels of one or both feet.

G.'s pathology of the item and clinical practice meets seldom. Gp is of the greatest importance for open and especially closed chest injuries, as well as for various operations on the neck and in the chest cavity. G. p. may be accompanied by an external outflow of chyle (external chylorrhea) or outflow of chyle into the pleural cavity (). The characteristic clinical manifestations of chylothorax are mainly due to compression of the lung, mediastinal displacement with symptoms of respiratory failure (Respiratory failure) and hemodynamic disturbances. The right-sided chylothorax is more pronounced than the left-sided one, which is associated with greater compliance of the left dome of the diaphragm and less pronounced displacement of the organs during the accumulation of chyle in the left pleural cavity.

In this case, there is a risk of damage to the recurrent, vagus and phrenic nerves.

II Thoracic duct (ductus thoracicus, BNA, JNA)

1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic dictionary of medical terms. - M.: Soviet Encyclopedia. - 1982-1984.

Veterinary Encyclopedic Dictionary

thoracic duct- (ductus thoracicus) the largest lymphatic vessel 30-40 cm long. It is formed in the upper abdominal cavity from the confluence of the right and left lumbar trunks. Along the length in the thoracic duct, the abdominal, thoracic and cervical parts are distinguished. AT… … Glossary of terms and concepts on human anatomy

One of the two main lymphatic ducts. Lymph passes through it from both lower extremities, from the lower abdomen, the left half of the chest and head, and also from the left arm. The thoracic duct flows into the left venous angle.

thoracic duct, ductus thoracicus (fig., see fig.), collects lymph from both lower extremities, organs and walls of the pelvic and abdominal cavities, left lung, left half of the heart, walls of the left half of the chest, from the left upper limb and left half of the neck and head.

The thoracic duct is formed in the abdominal cavity at the level of the II lumbar vertebra from the fusion of three lymphatic vessels: left lumbar trunk and right lumbar trunk, truncus lumbalis sinister et truncus lumbalis dexter, and intestinal trunk, truncus intestinalis.

The left and right lumbar trunks collect lymph from the lower extremities, the walls and organs of the pelvic cavity, the abdominal wall, the organs of the retroperitoneal space, the lumbar and sacral sections of the spinal column and the membranes of the spinal cord. The intestinal trunk collects lymph from the digestive organs of the abdominal cavity.

Both lumbar trunk and the intestinal trunk, when connected, sometimes form an enlarged section of the thoracic duct - thoracic duct cisterna, cisterna chyli. Often it may be absent, and then these three trunks flow directly into the thoracic duct. The level of education, the shape and size of the cistern of the thoracic duct, as well as the shape of the connection of these three ducts are individually variable.

The thoracic duct cistern is located on the anterior surface of the vertebral bodies from II lumbar to XI thoracic, between the crura of the diaphragm. The lower part of the cistern lies behind the aorta, the upper one along its right edge. It gradually narrows upward and continues directly into the thoracic duct. The latter, together with the aorta, passes through the aortic opening of the diaphragm into the chest cavity.

In the chest cavity, the thoracic duct is located in the posterior mediastinum along the right edge of the aorta, between it and v. azygos, on the anterior surface of the vertebral bodies. Here the thoracic duct crosses the anterior surface of the right intercostal arteries, being covered in front by the parietal pleura.

Heading upward, the thoracic duct deviates to the left, goes behind the esophagus and at the level of the III thoracic vertebra is to the left of it and thus follows to the level of the VII cervical vertebra. Then the thoracic duct turns forward, goes around the left dome of the pleura, passes between the left common carotid artery and the left subclavian artery and flows into the left venous angle - the confluence v. jugularis and v. subclavia sinistra.

In the chest cavity at the level of the VII-VIII vertebra, the thoracic duct can split into two or more trunks, which then reconnect. The terminal section can also split if the thoracic duct flows into the venous angle with several branches. In the chest cavity, the ductus thoracicus accepts small intercostal lymphatic vessels, as well as a large left bronchomediastinal trunk, truncus bronchomediastinalis sinister, from the organs located in the left half of the chest: the left lung, the left half of the heart, the esophagus and trachea - and from the thyroid gland.

At the confluence of the left venous angle, the ductus thoracicus takes into its composition two more large lymphatic vessels: 1) left subclavian trunk, truncus subclavius sinister collecting lymph from the left upper limb; 2) left jugular trunk, truncus jugularis sinister, - from the left half of the head and neck.

The length of the thoracic duct is 35-45 cm. The diameter of its lumen is not the same everywhere: in addition to the initial expansion - the cisternae, it has a slightly smaller expansion in the terminal section, near the confluence with the venous angle.

Along the duct lies a large number of lymph nodes. The movement of lymph along the duct is carried out, on the one hand, as a result of the suction action of negative pressure in the cavity of the chest and in large venous vessels, on the other hand, due to the pressor action of the legs of the diaphragm and the presence of valves. The latter are located throughout the thoracic duct. Especially a lot of valves in its upper section. The valves are located at the confluence of the duct into the left venous angle and prevent the reverse flow of lymph and the ingress of blood from the veins into the thoracic duct.

thoracic duct, ductus thoracicus , collects lymph from both lower extremities, organs and walls of the pelvic and abdominal cavities, the left lung, the left half of the heart, the walls of the left half of the chest, from the left upper limb and the left half of the neck and head.

The thoracic duct is formed in the abdominal cavity at the level of the II lumbar vertebra from the confluence of three lymphatic vessels: the left lumbar trunk and the right lumbar trunk, truncus lumbalis sinister et truncus lumbalis dexter, and intestinal trunk, truncus intestinalis.

The intestinal trunk collects lymph from the digestive organs of the abdominal cavity.

Both lumbar trunk and intestinal trunk, when connected, sometimes form an enlarged section of the thoracic duct - thoracic duct cisterna, cisterna chyli. Often it may be absent, and then these three trunks flow directly into the thoracic duct. The level of education, the shape and size of the cistern of the thoracic duct, as well as the shape of the connection of these three ducts are individually variable.

Then the thoracic duct turns forward, goes around the left dome of the pleura, passes between the left common carotid artery and the left subclavian artery and flows into the left venous angle - the confluence v. jugularis and v. subclavia sinistra.

In the chest cavity ductus thoracicus accepts small intercostal lymphatic vessels, as well as a large left bronchomediastinal trunk, truncus bronchomediastinalis sinister, from the organs located in the left half of the chest: the left lung, the left half of the heart, the esophagus and trachea - and from the thyroid gland.

At the confluence of the left venous angle, the ductus thoracicus takes into its composition two more large lymphatic vessels:

1) left subclavian trunk, truncus subclavius sinister collecting lymph from the left upper limb;

2) left jugular trunk, truncus jugularis sinister,- from the left side of the head and neck.

The length of the thoracic duct is 35-45 cm. The diameter of its lumen is not the same everywhere: in addition to the initial expansion - the cistern, it has a slightly smaller expansion in the terminal section, near the confluence with the venous angle.

Along the duct lies a large number of lymph nodes. The movement of lymph along the duct is carried out, on the one hand, as a result of the suction action of negative pressure in the chest cavity and in large venous vessels, on the other hand, due to the pressor action of the legs of the diaphragm and the presence of valves.

The latter are located throughout the thoracic duct. Especially a lot of valves in its upper section. The valves are located at the confluence of the duct into the left venous angle and prevent the reverse flow of lymph and the ingress of blood from the veins into the thoracic duct.

The thoracic lymphatic duct (ductus lymphaticus thoracicus) is laid at the level of the middle and lower thoracic vertebrae in the form of several isolated lymphatic slits or sacs, which then merge and form two lymphatic channels located along the unpaired and semi-unpaired veins. The right channel in a person usually becomes the main one. It goes to the left jugular lymphatic sac, formed by protrusion of the lateral walls of the internal jugular and subclavian veins. At the place of their confluence, the mouth of the thoracic lymphatic duct develops. The left lymphatic channel flows into the right main lymphatic channel at the level of the aortic arch. However, the left channel along its entire length is gradually reduced or remains in the form of a thin trunk located parallel to the right channel (in 37% of cases according to D.A. Zhdanov). The thoracic duct develops from the right lymphatic canal. The complex processes of development of the thoracic lymphatic duct cause a variety of options for its formation - complete doubling, the formation of several trunks, the formation of a bifurcation of the thoracic duct, in which two lymphatic trunks go to the right and left venous angles * There is also a right-sided, from the beginning to the mouth of the thoracic lymphatic duct (1 % of cases), flowing into the right venous angle, as well as an atypical confluence of the thoracic duct into the veins of the neck.
The thoracic duct collects lymph from almost the entire body, with the exception of the right half of the head and
neck, right upper limb, right half of the chest wall and chest cavity. From these areas, the right lymphatic duct receives lymph.
Externally, the lymphatic duct is a thin-walled, slightly tortuous tube similar to a vein.
The length of the lymphatic duct is from 30 to 41 cm. Its diameter in adults is uneven throughout: in the initial and final sections it reaches 8-12 mm, in the thoracic region it usually does not exceed 2-4 mm. When the thoracic duct is filled with lymph, its walls take on a color corresponding to the color of the lymph, normally whitish-yellow. During the day, 1.5-2 * 0 liters of lymph flows through the thoracic duct, which slowly, at intervals, flows into the venous system. In the thoracic duct, three sections are distinguished - retroperitoneal, thoracic and cervical.
Retroperitoneal thoracic lymphatic duct. The thoracic 1 duct is formed in the retroperitoneal space from the confluence of two lumbar lymphatic trunks - left and right. The intestinal lymphatic trunk flows into the beginning of the thoracic duct or into one of the lumbar trunks. The beginning of the thoracic duct can be located along the length from the upper edge of the vertebra Thx to the upper edge of the vertebra LJIr. Most often, the thoracic duct begins at the level of the vertebra LI or the intervertebral disc between the vertebrae Thxn and C in the midline or somewhat to the right of it. The beginning of the thoracic duct may have an extension - the lacteal cistern (cistemae hyli).
The thoracic region of the thoracic lymphatic duct. The boundaries of the thoracic duct are the upper edge of the aortic opening of the diaphragm and the level of attachment of the first rib to the sternum. In the chest cavity, the thoracic duct is located in the posterior and superior mediastinum. Accordingly, two of its departments can be distinguished: below the aortic arch - (subaortic) and above the aortic arch - (supraortal). In the posterior mediastinum, the thoracic duct runs through
the level of the vertebrae Thv_v in the form of a straight or slightly curved tube, located ventral to the spine in the sheets of the prevertebral fascia along the midline or somewhat to the right of it. To the left of the thoracic duct is the right edge of the descending aorta (aorta descendens), to the right is the unpaired vein (v. azygos).
At the level of the TKV1_I11 vertebrae, the thoracic duct begins to deviate to the left and forms bends of various sizes. Initially, it passes in an oblique direction dorsal to the aortic arch (arcus aortae), near its transition into the descending aorta. At this level, the thoracic duct is located behind the arterial ligament (ligamentum arteriosum). In children, the distance from the thoracic duct to the ligament is 1 cm. Above the aortic arch, at the level of the ThIn vertebra, the thoracic duct is adjacent to the prevertebral fascia and to the long neck muscle (m. longus colli) located under this fascia. Further, the thoracic duct passes dorsally to the initial sections of the left common carotid artery (a.carotis communis sinistra) and the left vagus nerve (n.vagus sinister). At this level, the thoracic duct is located to the left of the esophagus and is closely adjacent to the left mediastinal pleura and the fascia covering it. In cases where the duct is located dorsal to the esophagus, it does not adjoin the pleura.
Cervical thoracic lymphatic duct. From
In the thoracic cavity, the thoracic duct passes into the region of the neck, into the scale-vertebral triangle. At the level of Thj, the thoracic duct, located in the sheets of the prevertebral fascia between the esophagus and the left subclavian artery (a. subclavia sinistra), changes direction. It passes over the top of the dome of the pleura ventrally and to the left, forming a convex upward and right arc. The height of the thoracic duct arch, the ratio of the ascending and descending knees of the arc are not constant. According to D. A. Zhdanov, “-the highest point of the arch more often corresponds to the middle height of the vertebral body of the CVII. Duta can reach the level of the CVI vertebra or be located at the level of the Thj vertebra. This options
high and low position of the arc according to Yu.T. Komarovsky (1950) and V.Kh. Frauchi (1967). The level of location of the thoracic duct arc depends on the type of physique: in asthenics, the arc is usually located higher than in hypersthenics.
The arch of the thoracic duct passes dorsal to the fascial sheath of the left neurovascular bundle of the medial triangle of the neck and ventral to the arch of the left subclavian artery, the initial sections of the vertebral arteries and veins (a.vertebralis et v. vertebralis), the thyroid-cervical trunk (truncus thyreocervicalis) or the inferior thyroid artery (a.thyreoidea inferior), as well as the transverse artery of the neck (a.transversa colli) and above the legs of the agora artery (a. suprase apul aria). At the same time, the aroic inoodochei is close to the vertebral vein, kvtera *.* “ezhet be mistaken for it.
The arc of the thoracic lymphatic ductus can sometimes be located in the ventral cavity of the clavicular artery, and in the atypically * vertebral artery directly from the arches of the aorta, the trunk of the thoracic duct passes dorsally to it.
Dorsal of the thoracic duct and medial to the vertebral artery at the level of the head of the first rib is the lower cervical (ganglion cervicale inferius, BNA), or cervicothoracic, or stellate (grniglien-cervieofchoracicum stellatura, PNA) node of the border sympathetic trunk. Its preganglionic veins often circle the thoracic duct and create a risk of damage during sympathectomy.
Further, the duct passes into the distance of the medial “paradise of the anterior scalene muscle (m. scalenus anterior) and the phrenic nerve (n.phrenicus, ssh civ) in the prescalene cellular space (spatium antescalenum), heading towards the left venous corner. The phrenic nerve is located, as a rule, behind the arch of the duct or its mouth.
At this level, the thoracic duct is located behind the deep leaf of the own fascia of the neck (fascia III, according to

V.N. Shevkunenko), which forms the fascial sheaths of the sternothyroid (m. sternothuroideus) and scapular-hyoid (m.omohyoidens) muscles. In the prescalene tissue along the thoracic duct, there are lymph nodes and small veins that flow into the left venous angle.
The topography of the cervical thoracic duct is more variable than that of its thoracic duct. The main options are:

main (mono-main): a single trunk with a diameter of 2 mm 12 mm (60% of cases);
tree-like: several trunks of various diameters. One of the trunks is usually larger than the other rto diameter. Before falling into the venous angle, all trunks are connected;
loose (polymagistral): the thoracic duct is represented by several thin trunks, each of which independently flows into the veins of the neck.

After the lymph has passed through the lymph nodes, it is collected in lymph trunks and lymphatic ducts. A person has six such large trunks and ducts. Three of them flow into the right and left venous angles.

The main and largest lymphatic vessel is the thoracic duct. Through the thoracic duct, lymph flows from the lower extremities, organs and walls of the pelvis, the left side of the chest cavity and the abdominal cavity. Through the right subclavian trunk, lymph flows from the right upper limb, into the right jugular trunk from the right half of the head and neck. From the organs of the right half of the chest cavity, lymph flows into the right bronchomediastinal trunk, which flows into the right venous angle or into the right lymphatic duct. Accordingly, lymph flows through the left subclavian trunk from the left upper limb, and from the left half of the head and neck through the left jugular trunk, from the organs of the left half of the chest cavity, lymph flows into the left bronchomediastinal trunk, which flows into the thoracic duct.

thoracic lymphatic duct

The formation of the thoracic duct occurs in the abdominal cavity, in the retroperitoneal tissue at the level of the 12th thoracic and 2nd lumbar vertebrae during the connection of the right and left lumbar lymphatic trunks. The formation of these trunks occurs as a result of the fusion of the efferent lymphatic vessels of the right and left lymph nodes of the lower back. From 1 to 3 efferent lymphatic vessels belonging to the mesenteric lymph nodes, called intestinal trunks, flow into the initial part of the thoracic lymphatic duct. This is observed in 25% of cases.

The lymphatic efferent vessels of the intercostal, prevertebral, and visceral lymph nodes drain into the thoracic duct. Its length is from 30 to 40 cm.

The initial part of the thoracic duct is its abdominal part. In 75% of cases, it has an ampoule-shaped, cone-shaped or spindle-shaped extension. In other cases, this beginning is a reticular plexus, which is formed by the efferent lymphatic vessels of the mesenteric, lumbar and celiac lymph nodes. This extension is called a cistern. Usually the walls of this tank are fused with the right leg of the diaphragm. During breathing, the diaphragm compresses the thoracic duct, facilitating the flow of lymph.

The thoracic lymphatic duct from the abdominal cavity enters the chest cavity through the aortic opening and enters the posterior mediastinum. There it is located on the anterior surface of the spinal column, between the unpaired vein and the thoracic aorta, behind the esophagus.

The thoracic part of the thoracic duct is the longest. It originates at the aortic opening of the diaphragm and goes to the upper aperture of the chest, passing into the cervical duct. In the region of the 6th and 7th thoracic vertebrae, the thoracic duct deviates to the left, and exits from under the left edge of the esophagus at the level of the 2nd and 3rd thoracic vertebrae, rising up behind the left subclavian and left common carotid arteries and the vagus nerve. In the superior mediastinum, the thoracic duct runs between the left mediastinal pleura, esophagus, and spinal column. The cervical part of the thoracic lymphatic duct has a bend, forming an arc at the level of 5-7 cervical vertebrae, which goes around the dome of the pleura from above and slightly behind, and then opening with the mouth into the left venous angle or into the final section of the veins that form it. In half of the cases, the thoracic lymphatic duct expands before flowing into a vein, in some cases it bifurcates or has 3-4 stems that flow into the venous angle or into the terminal sections of the veins that form it.

The ingress of blood from the vein into the duct is prevented by a paired valve located at the mouth of the thoracic lymphatic duct. Also, along the entire length of the thoracic duct, there are from 7 to 9 valves that prevent the reverse movement of lymph. The walls of the thoracic duct have a muscular outer shell, the muscles of which contribute to the movement of lymph to the mouth of the duct.

In some cases (approximately 30%), the lower half of the thoracic duct has a doubling.

Right lymphatic duct

The right lymphatic duct is a vessel, 10 to 12 mm long. The broncho-mediastinal trunk, jugular trunk and subclavian trunk flow into it. It has an average of 2-3 sometimes more trunks, flowing into the angle formed by the right subclavian vein and the right internal jugular vein. In rare cases, the right lymphatic duct has one mouth.

jugular trunks

The right and left jugular trunks originate in the efferent lymphatic vessels of the lateral deep cervical right and left lymph nodes. Each consists of one vessel or several short ones. The right jugular trunk enters the right venous angle, into the final part of the right internal jugular vein, or forms the right lymphatic duct. The left jugular trunk enters the left venous angle, the internal jugular vein, or the cervical part of the thoracic duct.

Subclavian trunks

The right and left subclavian trunks originate from the efferent lymphatic vessels belonging to the axillary lymph nodes, most often the apical ones. These trunks go to the right and left venous angle, respectively, in the form of one trunk or several small ones. The right subclavian lymphatic trunk flows into the right venous angle, or into the right subclavian vein, the right lymphatic duct. The left subclavian lymphatic trunk flows into the left venous angle, the left subclavian vein, and in some cases it flows into the terminal part of the thoracic duct.