Wednesday, January 31, 2018

Dilated Cisterna Chyli: A Potential Mimicker of Lymphadenopathy

  ryan schwope
ryan schwope
Axial (top) and coronal (bottom) contrast-enhanced CT images
demonstrate a retrocrural fluid-filled tubular structure with imperceptible walls
 (black arrows), the classic imaging features of a cisterna chyli
    Ryan Schwope
    Coronal T2-weighted MRI shows the tubular cystic structure of the cisterna chili
    and it's continuity with the thoracic duct (white arrow)
  • The cistern chyli is a dilated lymphatic sac ommonly located in the right retrocrural region, at the level of L1-L2, extending 5-7 cm in CC dimension. It classically receives draining lymph from two lumbar trunks and an intestinal trunk, and continues cephalad as the thoracic duct
  • Can enhance on delayed MRI >5 min
  • Has an average size of 7.4 mm in the AP dimension, although some authors consider it dilated when ≥6 mm
  • Dilatation can be secondary to lymphatic damage from prior gastroesophageal or retroperitoneal surgery, uncompensated cirrhosis, hypoalbuminemialymphangioleiomyomatosis, elevated central venous pressure, and biliary obstruction
  • Size changes can vary depending on phase of respiration, hydration, and lower thoracic duct peristalsis
  • Important to know of this entity because it can mimic retrocrural lymphadenopathy in the oncologic setting
  • Mulitplanar reformations and MRI can help demontrsate the tubular cystic nature of the cistern chyli and its continuity with the thoracic duct 



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