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    Related Topics

    From Lymphatic System

    Pectoral Axillary Nodes
    Located along the anterior chest wall.
    Paratracheal Nodes
    Located lateral to the trachea.
    Pharyngeal Tonsil
    Located in the nasopharynx (adenoids).
    Lymphatic Capillaries
    Initial lymphatic vessels that collect interstitial fluid.
    Parotid Lymph Nodes
    Drain the lateral face and scalp.
    Inguinal Lymph Nodes
    Drain the lower limbs and external genitalia.
    Peyer’s Patches
    Lymphoid nodules in the small intestine.
    Bronchomediastinal Trunk
    Drains lymph from thoracic organs.
    Mastoid Lymph Nodes
    Drain the posterior scalp and ear.
    BALT
    Bronchus-associated lymphoid tissue.
    Tubal Tonsils
    Near openings of the auditory tubes.
    Tracheobronchial Nodes
    Drain lungs and bronchi.
    GALT
    Gut-associated lymphoid tissue.
    Iliac Lymph Nodes
    Include external, internal, and common iliac nodes.
    Submandibular Lymph Nodes
    Drain the face, mouth, and pharynx.
    Spleen
    Filters blood and initiates immune response.
    Occipital Lymph Nodes
    Drain the back of the scalp.
    Preaortic Nodes
    Located in front of the aorta.
    Anterior Mediastinal Nodes
    Drain anterior thoracic structures.
    Superficial Cervical Lymph Nodes
    Drain superficial structures of the head and neck.
    Apical Axillary Nodes
    Located at the apex of the axilla.
    Sacral Lymph Nodes
    Drain the pelvic floor and rectum.
    Intestinal Trunk
    Drains lymph from the intestines.
    Waldeyer’s Ring
    Ring of lymphoid tissue surrounding the naso- and oropharynx.
    Lymphatic Collecting Vessels
    Carry lymph through lymph nodes.

    Cisterna Chyli

    Reviewed by our medical team

    Dilated sac at the start of the thoracic duct.

    1. Overview

    The cisterna chyli is a dilated sac-like structure in the lymphatic system that serves as a major lymph-collecting reservoir. It marks the beginning of the thoracic duct and receives lymph from the lower limbs, pelvis, and abdomen. Functioning as a central convergence point, the cisterna chyli plays a vital role in transporting lymph—including lipid-rich chyle from the intestines—toward the thoracic duct and ultimately into the bloodstream. It is a crucial component in maintaining fluid balance and supporting immune and digestive functions.

    2. Location

    The cisterna chyli is located in the posterior abdominal cavity. Its specific anatomical landmarks include:

    • Position: Anterior to the bodies of the L1 and L2 vertebrae.

    • Posterior to: The abdominal aorta and between the right crus of the diaphragm and the inferior vena cava.

    • Superior continuation: It continues superiorly as the thoracic duct, which ascends through the aortic hiatus of the diaphragm into the thoracic cavity.

    Due to its deep and retroperitoneal location, it is not accessible by palpation or routine clinical examination, and it varies in size and shape among individuals.

    3. Structure

    The cisterna chyli is a thin-walled, elongated, sac-like structure usually measuring 2–5 cm in length and 0.5–1.5 cm in diameter. Its structural characteristics include:

    • Wall layers: Like other lymphatic vessels, it consists of an endothelial lining, a smooth muscle layer for propulsion, and an outer connective tissue adventitia.

    • Valves: Contains internal bicuspid valves that ensure unidirectional lymph flow toward the thoracic duct and prevent backflow.

    • Shape: May be tubular, fusiform, or saccular depending on individual anatomy.

    It receives afferent lymphatic input from the right and left lumbar trunks and the intestinal trunk, consolidating lymph and chyle into a single flow path.

    4. Function

    The cisterna chyli functions as a lymphatic reservoir and transit point for lymph from the lower body. Its primary functions include:

    • Collection of lymph: Gathers lymph from the lumbar trunks (draining the lower limbs, pelvis, and kidneys) and the intestinal trunk (draining the gastrointestinal tract).

    • Chyle transport: Carries chyle—a milky fluid composed of emulsified fats and lymph—from the intestines to the thoracic duct and ultimately to the bloodstream.

    • Initiation of the thoracic duct: Serves as the origin of the thoracic duct, the largest lymphatic vessel in the body.

    5. Physiological Role(s)

    The cisterna chyli plays several important physiological roles related to lymphatic, immune, and digestive functions:

    • Fluid balance: Facilitates the return of filtered interstitial fluid and plasma proteins from the lower half of the body to the central circulation.

    • Fat absorption: Transports dietary long-chain triglycerides absorbed in the small intestine as part of chyle via the intestinal trunk.

    • Immune cell transport: Moves immune cells such as lymphocytes and dendritic cells from peripheral tissues to lymphoid organs or into circulation for immune responses.

    • Detoxification and clearance: Indirectly supports clearance of metabolic waste and cellular debris through lymphatic drainage.

    6. Clinical Significance

    Chylous Disorders

    • Chylous ascites: Leakage or obstruction of lymph flow from the cisterna chyli can result in accumulation of chyle in the peritoneal cavity. Causes include trauma, malignancy (especially lymphoma), tuberculosis, or congenital lymphatic anomalies.

    • Chylothorax: Although more commonly associated with thoracic duct injury, disruption of the cisterna chyli can also lead to chyle entering the pleural space, especially in traumatic or postoperative scenarios.

    Surgical Risk

    Due to its deep position near the aorta and vertebral column, the cisterna chyli may be at risk during abdominal aortic surgery, spinal procedures, or retroperitoneal lymph node dissection. Injury can lead to persistent chyle leak, requiring conservative or surgical management.

    Imaging and Diagnosis

    Visualizing the cisterna chyli is typically achieved through specialized imaging techniques:

    • MR lymphangiography: A non-invasive method to visualize lymphatic channels, including the cisterna chyli and thoracic duct.

    • Lymphoscintigraphy: Nuclear imaging to assess lymphatic function and identify leaks or blockages.

    • CT/MRI: May incidentally reveal a dilated cisterna chyli, especially in cases of obstruction or malignancy.

    Anatomical Variability

    In some individuals, the cisterna chyli may be absent or replaced by a network of smaller lymphatic channels that directly form the thoracic duct. This anatomical variation is important to consider during lymphatic surgeries and imaging interpretation.

    Therapeutic Relevance

    Interventional procedures, such as lymphangiography-guided embolization, may target the cisterna chyli to manage persistent chyle leaks or lymphatic fistulas. These techniques have become valuable in minimally invasive management of lymphatic disorders.

    Did you know? The tonsils, located in the back of the throat, are the first line of defense against inhaled or ingested pathogens.