scholarly journals Biometric measurements involving the terminal portion of the thoracic duct on left level IV: an anatomic study

2015 ◽  
Vol 94 (1) ◽  
pp. 1
Author(s):  
Andressa Cristina Sposato Louzada ◽  
Soo Jin Lim ◽  
Alvaro Masahiro Yoshio ◽  
Vergilius José Furtado Araújo-Neto ◽  
Cesar Augusto Simões ◽  
...  
Keyword(s):  
Thoracic Duct ◽  
Jugular Vein ◽  
Brachiocephalic Vein ◽  
Left Internal Jugular Vein ◽  
Terminal Portion ◽  
Anatomic Study ◽  
Left Brachiocephalic Vein ◽  
Final Segment ◽  
Biometric Measurements ◽  
Omohyoid Muscle

<p>BACKGROUND: During a neck dissection involving the left IV level, the final segment of the thoracic duct (TD) may be injured, significantly increasing postoperative morbi-mortality. The best treatment is its prevention. However, there is a lack of helpful biometric measurements focusing on the TD termination in the literature. MATERIALS AND METHODS: The TD termination was identified and some helpful biometric measurements were obtained on 25 non-preserved cadavers. Statistical analysis was performed to analyze correlations. RESULTS: TD termination was found on the jugulo-subclavian junction (JSJ - 60%), on the left internal jugular vein (LIJV - 36%), and on the left brachiocephalic vein in 4%. A statistically significant association was found between TD termination on the JSJ and the distance between LIJV and omohyoid muscle (Measurement #1). Individuals with TD termination on the JSJ had median Measurement #1 of 34.5±12.0mm, compared with median Measurement #1 of 22.3±8.7mm among individuals with TD termination on LIJV (p=0.015 – Student´s t-test). The logistic regression showed for every 10mm increment of Measurement #1 there was 1.12x chance to find the TD termination on the JSJ (OR=1.12; CI95%:1,01-1,25; p=0.032). A 19mm cut-off was established for this distance as a diagnostic test to predict the TD termination on the JSJ, with sensitivity of 86.7% (CI95%:59.5-98.3%), specificity of 55.6% (CI95%:21.2-86.3%), PPV of 76.5% (CI95%:50.1-93.2%), NPV of 71.4% (CI95%:25.8-97.2%) and ROC AUC of 79.3% (CI95%: 58.0-92.9%). CONCLUSION: This anatomic study demonstrated the most frequent TD termination was on JSJ and Measurement #1 is able to predict the localization of TD termination.</p>

Biometric measurements involving the terminal portion of the thoracic duct on left cervical level IV: an anatomic study

2015 ◽  
Vol 91 (3) ◽  
pp. 274-279 ◽  
Author(s):  
Andressa Cristina Sposato Louzada ◽  
Soo Jin Lim ◽  
Jaqueline Fabiano Pallazzo ◽  
Viviane Passarelli Ramin Silva ◽  
Ruan Vitor Silva de Oliveira ◽  
...  
Keyword(s):  
Thoracic Duct ◽  
Terminal Portion ◽  
Anatomic Study ◽  
Biometric Measurements ◽  
Cervical Level

Factors Causing Loss of Normal Doppler Waveform of the Left Internal Jugular Vein: Evaluation on Chest Computed Tomography

2017 ◽  
Vol 18 (5) ◽  
pp. 402-407 ◽  
Author(s):  
Min Cheol Ku ◽  
Myung Gyu Song ◽  
Tae-Seok Seo ◽  
Eun Young Kang ◽  
Hwan Seok Yong ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Internal Jugular Vein ◽  
Doppler Ultrasound ◽  
Jugular Vein ◽  
Mediastinal Lymph Node ◽  
Brachiocephalic Vein ◽  
Left Internal Jugular Vein ◽  
Access Port ◽  
Chest Computed Tomography ◽  
Doppler Waveform

Purpose To evaluate the presence and causes of left brachiocephalic vein (LBCV) steno-occlusive lesions in patients with loss of normal waveform in Doppler ultrasound of the left internal jugular vein (LIJV). Materials and Methods We performed Doppler ultrasound of both internal jugular veins in 1912 patients who received an implantable venous access port from August 2013 to January 2016. Among them, 106 patients showed loss of normal Doppler waveforms of the LIJV (56 men and 50 women; mean age, 61.4 ± 11.6 years). We retrospectively analyzed the presence and causes of the LBCV steno-occlusive lesions on contrast-enhanced chest computed tomography (CT) images. Results LBCV steno-occlusive lesions were present in 82 patients (77.4%). The causes of these lesions were anatomic structures (n = 70, 85.4%), tumorous lesions (n = 11, 13.4%), and thrombus (n = 1, 1.2%). The anterior anatomic structures to the LBCV causing stenosis were bony structures (n = 50), right upper lobe (n = 11), and mediastinal fat (n = 9). The posterior anatomic structures to the LBCV resulting in stenosis were right brachiocephalic artery (n = 58), left common carotid artery (n = 7), and aortic arch (n = 5). The tumorous lesions resulting in stenosis were mediastinal lymph node (n = 5), thymic lesions (n = 3), lymphoma (n = 1), lung cancer (n = 1), and bone tumor (n = 1). Conclusions It is necessary to suspect steno-occlusive lesion of the LBCV from various causes and to use caution when performing central venous catheterization in cases with loss of a normal Doppler waveform.

Thoracic duct cysts: A rare differential diagnosis

2005 ◽  
Vol 132 (2) ◽  
pp. 330-333 ◽  
Author(s):  
Frank Gottwald ◽  
Heinrich Iro ◽  
Carsten Finke ◽  
Johannes Zenk
Keyword(s):  
Differential Diagnosis ◽  
Thoracic Duct ◽  
Jugular Vein ◽  
Primary Diagnosis ◽  
Imaging Method ◽  
Left Internal Jugular Vein ◽  
Duct Cyst ◽  
X Ray ◽  
Adjacent Structures ◽  
Rare Differential Diagnosis

OBJECTIVE: Cysts of the thoracic duct located in the supraclavicular region are uncommon. To date only 12 cases in this topographic area have been described in the literature. Between 1998 and 2002, 5 patients presented to our department with the primary symptom of a palpable soft left-supracavicular swelling that could be displaced relative to adjacent structures. SETTING: In each case, sonography showed a hypoechogenic, almost echo-free, distinctly outlined polycyclic structure with distal echo enhancement at the junction of the left internal jugular vein and the subclavian vein. All 5 patients underwent surgery, the cysts were extirpated, and the numerous communicating lymph vessels localized and meticulously ligated. Pathohistologic analysis of the milky, yellowish fluid obtained by intraoperative puncture confirmed the initial suspicion of a thoracic duct cyst in all patients. CONCLUSION: In the case of left supraclavicular masses, the rare differential diagnosis of a thoracic duct cyst must be considered as a possibility. Sonography as the imaging method of choice is sufficient for primary diagnosis. In addition, a thorax x-ray should be performed in order to exclude an intrathoracic involvement. Surgical extirpation marks the therapy of choice in treating such cysts.

Pre-procedural ultrasound-guided evaluation of left internal jugular vein and brachiocephalic vein: Experience on infants <1 year

2020 ◽  
pp. 112972982092569
Author(s):  
Filiz Uzumcugil
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Present Report ◽  
Brachiocephalic Vein ◽  
Complication Rates ◽  
Success Rates ◽  
Left Internal Jugular Vein ◽  
Ultrasound Guided ◽  
First Choice ◽  
Plane Technique

Pre-procedural evaluation of central veins prior to cannulation with ultrasound is essential to reduce the complication rates as well as to increase the success rates. The left brachiocephalic vein has been suggested to be considered as first choice in infants including the neonates due to its larger diameter and ease of access with supraclavicular, ultrasound-guided, in-plane technique. There are few studies on neonates and infants comparing the diameter of brachiocephalic vein with internal jugular vein being its most common alternative. The aim of the present report is to share our observations pertaining to the pre-procedural measurements of the diameters of left internal jugular vein and brachiocephalic vein in infants <1 year. The measurements were analysed in accordance with the weights of the infants (<2500 g and ⩾2500 g). In infants <2500 g, the brachiocephalic vein was larger than the internal jugular vein (4.0 ± 0.7 (3.2–5.2) mm vs 3.2 ± 0.7 (1.9– 4.3) mm, p = 0.032), whereas the diameters of two major veins were similar in infants ⩾2500 g (4.8 ± 1.2 (2.3–6.4) mm vs 5.1 ± 0.9 (2.8–6.7) mm, p = 0.363). Our observations support the suggestion of the brachiocephalic vein to be considered as the first choice for large-bore cannulation due to its larger diameter as well as its other advantages, especially in neonates <2500 g.

Dialysis Catheter Placement via the Left Internal Jugular Vein: Risk of Brachiocephalic Vein Perforation

2016 ◽  
Vol 17 (4) ◽  
pp. e75-e78 ◽  
Author(s):  
Michiel B. Winkes ◽  
Maarten J. Loos ◽  
Marc R. Scheltinga ◽  
Joep A. Teijink
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Catheter Placement ◽  
Brachiocephalic Vein ◽  
Dialysis Catheter ◽  
Left Internal Jugular Vein

Use of Intraoperative Venography to Guide the Distal Portion of a Ventriculoatrial Shunt Past an Obstruction in the Central Veins

2010 ◽  
Vol 66 (suppl_2) ◽  
pp. onsE370-onsE371 ◽  
Author(s):  
Eric N. Momin ◽  
Pablo F. Recinos ◽  
Alexander L. Coon ◽  
Daniele Rigamonti
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Standard Technique ◽  
Pseudotumor Cerebri ◽  
Distal Portion ◽  
Brachiocephalic Vein ◽  
Considerable Difficulty ◽  
Left Brachiocephalic Vein ◽  
Ventriculoperitoneal Shunting ◽  
Atrial Catheter

Abstract OBJECTIVE Ventriculoatrial (VA) shunting is commonly used to treat hydrocephalus when ventriculoperitoneal shunting has failed. Placement of a VA shunt in patients with narrowing or occlusion of the central veins presents considerable difficulty because few imaging modalities exist to safely and reliably insert a guidewire or atrial catheter past the occlusion. We report the use of intraoperative venography to guide the placement of the distal portion of a VA shunt in a patient with a valve blocking the left brachiocephalic vein. CLINICAL PRESENTATION A 42-year-old man with pseudotumor cerebri and a left ventriculoperitoneal shunt presented with severe headaches. He was diagnosed with partial distal shunt obstruction. Because of a history of failed attempts at ventriculoperitoneal shunting, conversion to a VA shunt via the left internal jugular vein was planned. TECHNIQUE Surgery was performed by using the standard technique until resistance was encountered when inserting a guidewire into the internal jugular vein. Intraoperative venography of the central veins was performed, which showed a large valve blocking progression of the guidewire in the left brachiocephalic vein. Using fluoroscopic guidance, a 0.035-inch guidewire was successfully directed through the vein past the obstruction and exchanged for a peel-away introducer. The distal shunt catheter was then inserted, and the correct position in the atrium was confirmed fluoroscopically. CONCLUSION When obstruction of the central veins is found during a VA shunting procedure, intraoperative venography is a useful method to aid in the placement of the atrial catheter through the central veins.

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