{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:30:37Z","timestamp":1792042237030,"version":"4.4.0"},"reference-count":63,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2013,12,2]],"date-time":"2013-12-02T00:00:00Z","timestamp":1385942400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Anatomy"],"published-print":{"date-parts":[[2014,5]]},"abstract":"<jats:p>The thoracic duct (TD) transports ingested fat, drains lymph from the gastrointestinal vascular bed, and delivers the lymph to central veins in the neck. Preliminary evidence suggests that diversion of TD lymph may mitigate the severity of end\u2010organ dysfunction in critical illness. Variations in the anatomy of the TD may determine whether reliable and safe cannulation of the duct, a necessary step for diversion, is possible. A systematic review was undertaken using the Google Scholar, MEDLINE, PubMed, and Scopus databases until 31st March, 2013. Both English and non\u2010English articles were searched for, and surgical, cadaveric, and radiologic studies were included. Fifty\u2010seven articles from the past 102 years were retrieved. There are significant variations in the anatomy of the TD in terms of its formation at the cisterna chyli, its course through the thorax, and its termination in the venous system. The most common site of termination is at the internal jugular vein (46%), followed by the jugulosubclavian angle (32%), and the subclavian vein (18%). An improved understanding of the anatomy of the TD would help surgeons to avoid inadvertent injury and potentially afford new opportunities for diagnosis and intervention in patients with critical illness. Clin. Anat. 637\u2013644, 2014. \u00a9 2013 Wiley Periodicals, Inc.<\/jats:p>","DOI":"10.1002\/ca.22337","type":"journal-article","created":{"date-parts":[[2013,12,2]],"date-time":"2013-12-02T23:13:12Z","timestamp":1386025992000},"page":"637-644","source":"Crossref","is-referenced-by-count":157,"title":["Review of thoracic duct anatomical variations and clinical implications"],"prefix":"10.1002","volume":"27","author":[{"given":"K.","family":"Phang","sequence":"first","affiliation":[{"name":"Department of Surgery School of Medicine Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Bowman","sequence":"additional","affiliation":[{"name":"Department of Surgery School of Medicine Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Phillips","sequence":"additional","affiliation":[{"name":"Department of Surgery School of Medicine Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand"},{"name":"School of Biological Science University of Auckland Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Windsor","sequence":"additional","affiliation":[{"name":"Department of Surgery School of Medicine Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,12,2]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"1","article-title":"Der Ductus Thoracicus der Japaner","author":"Adachi B.","year":"1953","journal-title":"Kyoto: Deutsch\u2013Japanisches Kulturinstitut: Druckanstalt Kenkyusha"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-006-0082-3"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1010-7940(98)00230-9"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000093826.31666.A5"},{"key":"e_1_2_6_6_1","first-page":"336","volume-title":"An Atlas of Human Anatomy","author":"Anson BJ","year":"1950"},{"key":"e_1_2_6_7_1","first-page":"211","article-title":"40 Dissections of the thoracic duct; its termination in the living human being","volume":"222","author":"Archimbaud JP","year":"1969","journal-title":"Lyon Med"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI58050"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2007.11.028"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800780521"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(96)70152-6"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/ca.20178"},{"key":"e_1_2_6_13_1","first-page":"1","article-title":"Le canal thoracique chez l'homme","volume":"1","author":"Correia","year":"1926","journal-title":"Folia Anatomica Universitatis Conimbrigensis"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-197606000-00008"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/aja.1000170203"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0347(199607\/08)18:4<347::AID-HED6>3.0.CO;2-Y"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.shk.0000133592.55400.83"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00261496"},{"key":"e_1_2_6_19_1","first-page":"135","article-title":"A study of the gross, microscopic and functional anatomy of the thoracic duct and the lympho\u2010venous junction","volume":"68","author":"El Zawahry MD","year":"1983","journal-title":"Int Surg"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.182.1.1820262"},{"key":"e_1_2_6_21_1","first-page":"374","article-title":"Mesenteric lymph: The bridge to future management of critical illness","volume":"8","author":"Fanous MYZ","year":"2007","journal-title":"JOP"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-008-1116-5"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1956.01280060055012"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.212.2.r99au23598"},{"key":"e_1_2_6_25_1","volume-title":"Clinical Anatomy and Pathology of the Thoracic Duct: An Investigation of 122 Cases","author":"Jacobsson S\u2010I","year":"1972"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1159\/000141456"},{"key":"e_1_2_6_27_1","first-page":"68","article-title":"Der anfang des ductus thoracicus und dessen erweiterung","volume":"1","author":"Jossifow GM","year":"1906","journal-title":"Archiv fur Anat. und Physiol"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/aja.1000400302"},{"key":"e_1_2_6_29_1","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/S0096-5588(20)30312-3","article-title":"Anatomic and pathologic studies of the thoracic duct","volume":"34","author":"Kausel HW","year":"1957","journal-title":"J Thorac Surg"},{"key":"e_1_2_6_30_1","first-page":"45","article-title":"Anatomical variations of the cervical portion of the thoracic duct in man","volume":"115","author":"Kinnaert P","year":"1973","journal-title":"J Anat"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr\/19379150"},{"key":"e_1_2_6_32_1","first-page":"44","article-title":"Drainage of the thoracic duct in peritonitis","author":"Kochnev OS","year":"1987","journal-title":"Khirurgiia (Mosk)"},{"key":"e_1_2_6_33_1","first-page":"61","article-title":"The technique of prolonged thoracic duct drainage in transplantation","volume":"151","author":"Koep LJ","year":"1980","journal-title":"Surg Gynecol Obstet"},{"key":"e_1_2_6_34_1","first-page":"56","article-title":"Valves of the thoracic duct in man","volume":"34","author":"Koroleva T","year":"1957","journal-title":"Arkh Anat Gistol Embriol"},{"key":"e_1_2_6_35_1","first-page":"243","article-title":"[Anatomy of the lymphatic system]","volume":"42","author":"Kubik S","year":"1973","journal-title":"Radiol Clin Biol"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1051-0443(07)61730-8"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1054\/jcms.2002.0298"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00276-997-0053-3"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.05.1173"},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/ca.20485"},{"key":"e_1_2_6_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2007.10.025"},{"key":"e_1_2_6_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2012.01.078"},{"key":"e_1_2_6_43_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800570407"},{"key":"e_1_2_6_44_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11604-010-0515-0"},{"key":"e_1_2_6_45_1","first-page":"720","article-title":"Aggressive treatment of chylothorax complicating transhiatal esophagectomy without thoracotomy","volume":"104","author":"Orringer MB","year":"1988","journal-title":"Surgery"},{"key":"e_1_2_6_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)66967-2"},{"key":"e_1_2_6_47_1","doi-asserted-by":"publisher","DOI":"10.1089\/lrb.2008.1001"},{"key":"e_1_2_6_48_1","first-page":"40","article-title":"Thoracic duct valves in man and albino rat","volume":"126","author":"Petrenko VM","year":"2004","journal-title":"Morfologiia"},{"key":"e_1_2_6_49_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800551208"},{"key":"e_1_2_6_50_1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.243035086"},{"key":"e_1_2_6_51_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1442-2050.2004.00391.x"},{"key":"e_1_2_6_52_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.05.1795"},{"key":"e_1_2_6_53_1","first-page":"651","article-title":"Research on the composition of human lymph. Surgical anatomy of the thoracic duct at the neck and catheterization technic","volume":"63","author":"Rocca Rossetti S","year":"1961","journal-title":"Rass Med Sarda"},{"key":"e_1_2_6_54_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.44.1127.145"},{"key":"e_1_2_6_55_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00270-010-9898-7"},{"key":"e_1_2_6_56_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2531082036"},{"key":"e_1_2_6_57_1","first-page":"814","article-title":"Cannulation of the human thoracic lymph duct","volume":"45","author":"Shafiroff BG","year":"1959","journal-title":"Surgery"},{"key":"e_1_2_6_58_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1098-2353(1997)10:3<163::AID-CA2>3.0.CO;2-V"},{"key":"e_1_2_6_59_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.124.6.2136"},{"key":"e_1_2_6_60_1","first-page":"323","article-title":"The embryonic development of the main lymphatics in man","volume":"18","author":"Der Putte SCJ","year":"1980","journal-title":"Acta Morphol Neerl Scand"},{"key":"e_1_2_6_61_1","first-page":"806","article-title":"Variations of the thoracic duct","volume":"26","author":"Pernis PA","year":"1949","journal-title":"Surgery"},{"key":"e_1_2_6_62_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.0007-1323.2001.01896.x"},{"key":"e_1_2_6_63_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.22128"},{"key":"e_1_2_6_64_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmor.1051530303"}],"container-title":["Clinical Anatomy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fca.22337","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ca.22337","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,6]],"date-time":"2023-10-06T06:40:32Z","timestamp":1696574432000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ca.22337"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,12,2]]},"references-count":63,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2014,5]]}},"alternative-id":["10.1002\/ca.22337"],"URL":"https:\/\/doi.org\/10.1002\/ca.22337","archive":["Portico"],"relation":{},"ISSN":["0897-3806","1098-2353"],"issn-type":[{"value":"0897-3806","type":"print"},{"value":"1098-2353","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,12,2]]}}}