Begins at the cisterna chyli, crosses to the left at T5, drains into the left venous angle
Mnemonic
“It starts on the right and ends on the left, crossing at T5”:
- Begins at the cisterna chyli at L1 to L2
- Enters the thorax through the aortic hiatus at T12
- Ascends on the right of the midline
- Crosses to the left at about T5
- Empties at the left jugulovenous angle, the junction of the left subclavian and internal jugular veins
It drains everything except the right upper quadrant of the body: the right side of the head and neck, the right arm and the right thorax drain via the right lymphatic duct.
That asymmetry is why Virchow’s node is on the left: the thoracic duct carries malignant cells from the whole abdomen to the left supraclavicular fossa.
Injury during oesophagectomy or neck dissection causes a chylothorax, which is milky, rich in triglycerides (over 1.24 mmol/l) and treated with a low fat or medium chain triglyceride diet, or duct ligation.
Expansion
- Begins as the cisterna chyli at about L1 to L2
- Enters the thorax through the aortic hiatus at T12
- Ascends on the right of the midline, between the aorta and the azygos vein
- Crosses the midline to the left at about T5
- Drains into the junction of the left subclavian and left internal jugular veins
Because it ends at the left venous angle, malignancy tracking up the duct can seed the left supraclavicular node, Virchow’s node, and the basis of Troisier’s sign.
Injury during oesophageal or thoracic surgery produces a chylothorax, which is characteristically milky and rich in triglycerides.