What makes up the thoracic duct

It originates in the abdomen from the confluence of the right and left lumbar trunk and the intestinal trunk , forming a significant pathway upward called the cisterna chyli. It extends vertically in the chest and curves posteriorly to the left carotid artery and left jugular vein at the C7 vertebral level to empty into the junction of the left subclavian vein and left jugular vein , below the clavicle , near the shoulders.

It traverses the diaphragm at the aortic aperture and ascends the posterior mediastinum between the descending thoracic aorta to its left and the azygos vein to its right. The lymph transport in the thoracic duct is mainly caused by the action of breathing , aided by the duct's smooth muscle and by internal one way valves which prevent the lymph from flowing back down again.

There are also two valves at the junction of the duct with the left subclavian vein, to prevent the flow of venous blood into the duct. When the thoracic duct is blocked or damaged a large amount of lymph can quickly accumulate in the pleural cavity , this situation is called chylothorax.

The first sign of a malignancy especially an intraabdominal one may be an enlarged Virchow's node , a lymph node in the left supraclavicular area, in the vicinity where the thoracic duct empties into the left subclavian vein. It is also known under various other names including the alimentary duct , chyliferous duct , duct of Pecquet , the left lymphatic duct and Van Hoorne's canal.

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