Investig Magn Reson Imaging.  2019 Sep;23(3):276-278. 10.13104/imri.2019.23.3.276.

Left-Sided Cisterna Chyli: a Case Report on a Rare Normal Anatomic Structure

• Seo JH
• Hwang JA
• Shin HC
• Kim SS
• Park CH
• Lee HN

• KMID: 2459883
• DOI: http://doi.org/10.13104/imri.2019.23.3.276

Abstract

The cisterna chyli, a dilated lymphatic sac in the retrocrural space, is usually located to the right of the aorta. We report a case of a left-sided cisterna chyli, which was incidentally detected on the radiologic examinations of a preoperative workup for cholangiocarcinoma. Computed tomography (CT) and magnetic resonance (MR) images revealed a cisterna chyli measuring 2.5 cm in length in the left retrocrural space. The dilated lumbar lymphatics joined with the cisterna chyli, which was continuous with the left-sided thoracic duct. To the best of our knowledge, this is the second antemortem case of a left-sided cisterna chyli in literature. The cisterna chyli can mimic retrocrural lymphadenopathy, solid tumor with cystic degeneration, abscess or hematoma. The left-sided cisterna chyli should be referred to as a structure so as to be cautious in surgical approach.

Keyword

Cisterna chyli; Thoracic duct; Lymphatic abnormalities

MeSH Terms

Abscess
Aorta
Cholangiocarcinoma
Hematoma
Lymphatic Abnormalities
Lymphatic Diseases
Thoracic Duct*

Figure

• 

  Fig. 1 An incidentally-detected left-sided cisterna chyli in a 76-year-old man. Contrast enhanced CT image showed a well-defined non-enhancing lesion (arrow) measuring 1.2 × 1.4 × 2.5 cm of near-water attenuation. It was located in the left retrocrural space between the T12 and L1 vertebral level.

• 

  Fig. 2 MR coronal T2-weighted image (a) and coronal maximum intensity projection MR Cholangiopancreatography image (b) revealed dilated lumber lymphatics (arrowheads) converged to form a localized cystic structure demonstrating the classical appearance of a cisterna chyli (arrow). The cisterna chyli was situated in the left retrocrural space and was continuous with the left-sided thoracic duct (open arrows) at cephalad.

Reference

1. Rosenberger A, Abrams HL. Radiology of the thoracic duct. Am J Roentgenol Radium Ther Nucl Med. 1971; 111:807–820.

2. Meguid RA. Chylothorax: surgical ligation of the thoracic duct through thoracotomy. Oper Tech Thorac Cardiovasc Surg. 2016; 21:139–151.

3. Kurosaki Y, Fujikawa A. Left-sided cisterna chyli. AJR Am J Roentgenol. 2000; 175:1462.

4. Kiyonaga M, Mori H, Matsumoto S, Yamada Y, Sai M, Okada F. Thoracic duct and cisterna chyli: evaluation with multidetector row CT. Br J Radiol. 2012; 85:1052–1058.

5. Pinto PS, Sirlin CB, Andrade-Barreto OA, Brown MA, Mindelzun RE, Mattrey RF. Cisterna chyli at routine abdominal MR imaging: a normal anatomic structure in the retrocrural space. Radiographics. 2004; 24:809–817.

6. Lee KC, Cassar-Pullicino VN. Giant cisterna chyli: MRI depiction with gadolinium-DTPA enhancement. Clin Radiol. 2000; 55:51–55.

7. Gollub MJ, Castellino RA. The cisterna chyli: a potential mimic of retrocrural lymphadenopathy on CT scans. Radiology. 1996; 199:477–480.

8. Rha SE, Byun JY, Jung SE, Chun HJ, Lee HG, Lee JM. Neurogenic tumors in the abdomen: tumor types and imaging characteristics. Radiographics. 2003; 23:29–43.

9. Restrepo CS, Eraso A, Ocazionez D, Lemos J, Martinez S, Lemos DF. The diaphragmatic crura and retrocrural space: normal imaging appearance, variants, and pathologic conditions. Radiographics. 2008; 28:1289–1305.