The cisterna chyli is a dilated sac representing the origin of the thoracic duct, lying on the anterior surface of L1-L2 vertebrae between the aorta and the right crus of the diaphragm. It receives the left and right lumbar lymphatic trunks and the intestinal lymphatic trunk carrying chyle from the gut. Its size and shape are variable; it may be absent, replaced by a plexus of channels.
The cisterna chyli is visualised on CT as a tubular structure at the L1-L2 level between the aorta and spine, sometimes filled with fat-density chyle. It is relevant in retroperitoneal dissection for aortic surgery and right-sided lymph node dissection. Chylous ascites from cisterna chyli disruption follows blunt abdominal trauma, retroperitoneal surgery, or lymphoma. Lymphangiography via the cisterna chyli or pedal lymphatic injection maps the thoracic duct for therapeutic embolisation of chylothorax.
Blunt abdominal trauma or retroperitoneal surgery disrupting the cisterna chyli causes chylous ascites with a creamy peritoneal fluid containing chylomicrons, managed by medium-chain triglyceride diet and peritoneal drainage, with surgical or interventional ligation of the cisterna chyli for persistent leaks.
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