Conservative management of chyle leak after left neck dissection by lipoidol lymphangiography, a rare case report with review of literature.

Resumen

The Thoracic duct is the largest lymphatic channel in the body carrying lymph from the entire left side of the body and right lower half of the body below the diaphragm into the venous system ¹ The thoracic duct typically starts at the second lumbar vertebra from the superior aspect of cisterna chyli, on the right side then crossing to the left side (at T4), ending at the junction of the left subclavian and left internal jugular vein in the neck with considerable variation in its termination ².The duct is about 45 cm long with a diameter of approximately 2 - 5 mm. Chyle is the fluid transported by the thoracic duct from the cisterna chyli into the venous system. Chyle is rich in chylomicrons, triglycerides, cholesterol and fat-soluble vitamins and also contains albumin in high concentrations (12-14 g/L). Besides, the chyle is rich in lymphocytes, which account for 95% of the cell content, and this keeps the chyle mostly sterile. Electrolytes like sodium, potassium, chloride and glucose and other enzyme levels in chyle are similar as that of the plasma ^3,4. Approximately 2 - 4 liters of chyle is transported through the thoracic duct each day, the production however varies with dietary intake, activity level, respiratory movements, intestinal motility, intra-abdominal pressure variations