Life-threatening anomalies of the thoracic duct: Anatomic delineation dictates management

Congenital anomalies of the thoracic duct are rare, poorly characterized, a nd difficult to manage. The spectrum of pathophysiologic perturbations, pre senting symptoms, radiographic findings, and interventions performed in 4 p atients are shown. Accurate anatomic delineation of the malformation was on ly possible by direct injection contrast lymphangiography. Therapies tailor ed to address the anatomic aberrations included intralesional sclerotherapy , surgical excision and ligation, lymphovenous anastomosis, and omental int erposition to interrupt dysfunctional collateral lymphatics to the lung. Ac curate anatomic diagnosis of central lymphatic channel anomalies by contras t lymphangiography facilitates an individualized multidisciplinary approach to repair. J Pediatr Surg 36:1269-1272. Copyright (C) 2001 by W.B. Saunder s Company.