Thoracic Anatomy

Question 1

Thoracic Duct

Answer 1

Continuaton of the cisterna chyli in the abdomen
Enters thorax at T12
Lies posterior to the osesophagus for most of its thoracic course. Passes to the left at T5.
Lymphatics draining the left side of head and neck join the duct prior to its insertion into the left brachiocephalic vein
Lymphatics draining the right side of head and neck drain via subclavian and jugular trunks into the right lymphatic duct and then into the mediastinal trunk and then into right brachiocephalic vein
Due to location, it is prone to injury in oesophageal surgery. Some surgeons administer cream to pts prior to oesphagectomy so that it is easier to identify the cut ends of the duct.

Question 2

Anatomical structures at the level of the manubrium and upper sternum

Answer 2

Upper part of the manubrium

• Left brachiocephalic vein
• Brachiocephalic artery
• Left common carotid
• Left subclavian artery

Lower part of the manubrium/ manubrio-sternal angle

• Costal cartilages of the 2nd ribs
• Transition point between superior and inferior mediastinum
• Arch of the aorta
• Tracheal bifurcation
• Union of the azygos vein and superior vena cava
• The thoracic duct crosses to the midline