Thoracic duct
Collecting ducts · T12 hiatus Crosses at T5 3/4 of body
The main lymph channel of the body, about 38-45 cm long: it begins at L1-L2, enters the thorax through the aortic hiatus at T12, ascends to the right of the midline between aorta and azygos vein, crosses to the left at about T5, then arches over the left subclavian artery to end at the left venous angle. It drains three-quarters of the body, meaning everything below the diaphragm plus the left head, neck, upper limb and thorax.
Traced from the start
- Testis and ovary
- Lower limb, scrotum and perineal skin
- Para-aortic (lumbar) nodesSuperficial and deep inguinal nodes
- Gut and abdominal viscera
- Preaortic nodes (coeliac, superior and inferior mesenteric)
- Head and neck
- Deep cervical nodesLeft supraclavicular (Virchow's) node
- Upper limbBreast
- Axillary nodes
- Lungs and thoracic viscera
- Tracheobronchial and mediastinal nodesParasternal (internal mammary) nodes
- Right and left lumbar trunksIntestinal trunkJugular lymph trunksSubclavian lymph trunksBronchomediastinal trunks
- Thoracic duct
Detail
- Length
- About 38-45 cm
- Begins
- Cisterna chyli at L1-L2
- Enters the thorax
- Aortic hiatus at T12, with the aorta and azygos vein
- Crosses the midline
- About T5 (T5-T6)
- Thoracic relations
- Between the aorta and azygos vein, behind the oesophagus
- Ends
- Left venous angle, guarded by a bicuspid valve
- Territory
- Everything below the diaphragm plus the left upper quadrant of the body
When it goes wrong
Injury during oesophagectomy, aortic surgery or left level IV neck dissection
Chylothorax or a chylous neck fistula with litres of daily loss
Tumour emboli ascending the duct
Deposit in the left supraclavicular (Virchow's) node at its termination
Practise this structure
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