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Ann Thorac Surg 2002;73:898-899
© 2002 The Society of Thoracic Surgeons

Invited commentary

^a Division of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, 200 First St, SW, Rochester, MN 55905, USA

e-mail: miller.danielmd{at}mayo.edu

The article by Dr Riquet and colleagues offers a detailed look at the complex anatomy of the thoracic duct and its tributaries. A thorough understanding of the anatomy of the thoracic duct is essential when performing procedures within the thoracic cavity to prevent the complication of a chylothorax. Although the mortality of a chylothorax secondary to injury of the thoracic duct has decreased significantly over the last several decades, it still can lead to significant morbidity and prolonged hospitalization. The incidence of chylothorax after thoracic procedures ranges from 0.5% to 2.5% and can occur after any thoracic procedure. The majority of chylothoraces are related to direct injury to the thoracic duct. Other causes are less clear.

Injury to the intrathoracic tributaries eloquently described by Dr Riquet and colleagues may contribute to these other causes. It is not uncommon that after an extensive mediastinal lymphadenectomy that a chylothorax can occur, which may be explained by injury to thoracic duct tributaries. These injuries may be treated conservatively rather than by direct thoracic duct ligation if the injury is related to these tributaries. However, if there is associated proximal thoracic duct obstruction or valve insufficiently, the associated chylothorax will persist and more than likely require thoracic duct ligation.

The consistency of these tributaries not only from the lungs but also from the esophagus, heart, and diaphragm was of interest. Formal knowledge of these intrathoracic tributaries may help us better understand the dissemination patterns of intrathoracic malignancies, which could improve survival and prevent recurrence in these usually fatal malignancies. As sentinel node studies become more common practice in the treatment of thoracic malignancies, intrathoracic thoracic duct tributaries will become more important.

The authors are to be commended for their labor-intensive study of the tributaries of the thoracic duct system. This will undoubtedly be an important contribution to the literature on the normal anatomy within in the chest cavity and its relationship with thoracic malignancies.

Related Article

Thoracic duct tributaries from intrathoracic organs

Marc Riquet, Françoise Le Pimpec Barthes, Redha Souilamas, and Geneviève Hidden
Ann. Thorac. Surg. 2002 73: 892-898. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Miller, D. L. Search for Related Content PubMed Articles by Miller, D. L. Related Collections Related Article