Anatomical variations in distal portion of the thoracic duct-A systematic review.
Level 1 - systematic review of randomized trials
Systematic review of observational and anatomical cadaveric/radiologic studies (by design analogy).
PubMed 31576619 · doi:10.1002/ca.23476
What was done
The authors conducted a systematic review searching PubMed/Medline and reference lists for studies evaluating anatomical variations in the termination of the distal thoracic duct. Eligible studies assessed cadaveric dissections, surgical procedures, or radiological investigations in humans.
What was found
Across 20 included review articles covering 1,352 thoracic ducts, study findings were heterogeneous. The thoracic duct most commonly terminated in the internal jugular vein in 54.05% of cases (95% CI: 54.03–54.07), in the jugular-venous angle in 25.79% (95% CI: 25.77–25.81), in the subclavian vein in 8.16% (95% CI: 8.14–8.18), and at other sites in 12.00% of cases.
Why it matters
Understanding the common termination variants of the cervical thoracic duct aids surgeons and interventional radiologists in avoiding complications such as chylothorax during neck and thoracic procedures.
Limits
The search was limited to a single electronic database (Medline/PubMed) and reference lists. Included studies pooled heterogeneous modalities (cadavers, surgery, radiology), and the abstract notes heterogeneity without detailing risk of bias or quality assessment of the primary literature.
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