Thoracic duct relationships to abnormal neurovascular structures in cervicothoracic regions: case study and clinical rel
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Thoracic duct relationships to abnormal neurovascular structures in cervicothoracic regions: case study and clinical relevance N. Eid • Y. Ito • Y. Otsuki
Received: 26 October 2012 / Accepted: 19 March 2013 Ó Springer-Verlag France 2013
Abstract The presence of variant intercostal and bronchial arteries and variable position of left recurrent laryngeal nerve (LRLN) along the course of thoracic duct (TD) may have clinical relevance in various cervicothoracic surgeries. Keywords Thoracic duct Anomalous bronchial artery Innervation
Introduction The presence of variant blood vessels or nerves in close relationship to the TD may have clinical relevance to TD injury in various mediastinal and cervical surgeries.
Case study The TD was traced from its origin until termination in old female during the dissection of 25 cadavers at anatomy department, Osaka medical college. After passing through the aortic hiatus, the TD ascended normally behind the esophagus between descending aorta and azygos vein until the level of tracheal bifurcation (T4–5) where it became paraesophageal (Fig. 1, inset). The duct passed upward through a vascular tunnel formed by anomalous bifurcated right posterior intercostals artery (Fig. 1, inset), then passed deep to the aortic arch. Sectioning and retraction of
N. Eid (&) Y. Ito Y. Otsuki Division of Life Sciences, Department of Anatomy and Cell Biology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan e-mail: [email protected]; [email protected]
aortic arch ventrally revealed that the TD passed deep to variant common bronchial artery trunk arising from the aortic arch at its junction with descending aorta. At this location, the LRLN looped under the aortic arch superficial to both the TD and the variant common bronchial artery trunk (Fig. 1). Thus, the common bronchial artery trunk near its origin was between LRLN ventrally and TD dorsally. The bronchial artery crossed the left main bronchus ventrally toward the carina where it terminated at the right main bronchus after giving branches to both bronchi. The TD was followed cranially to the superior mediastinum and root of the neck (Fig. 2 and left inset). The TD ascended deep to the left subclavian artery then reappeared between the latter artery and the esophagus close to and just deep to LRLN within a vascular cervical triangle formed by left subclavian, left common carotid and inferior thyroid arteries. The TD then arched crossing ventral to the sympathetic trunk and left subclavian artery below the inferior thyroid artery where it received a branch from the middle cervical ganglion (Fig. 2), right lower inset). In addition, the latter ganglion sent a nerve loop; ansa subclavia just above the dome part of TD. The duct finally descended down crossing the vertebral vein superficially to its termination at the venous angle.
Discussion Normally and during ascent of the TD through the posterior mediastinum, the thoracic vertebrae, right intercostal arteries, and terminal portions
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