The cisterna chyli: a systematic review of definition, prevalence, and anatomy

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  • Sara Moazzam
    School of Medicine, The University of Auckland, Auckland, New Zealand
  • Lomani A. O’Hagan
    School of Medicine, The University of Auckland, Auckland, New Zealand
  • Alys R. Clarke
    Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
  • Maxim Itkin
    Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
  • Anthony R. J. Phillips
    Applied Surgery and Metabolism Laboratory, School of Biological Sciences, The University of Auckland, Auckland, New Zealand
  • John A. Windsor
    Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
  • S. Ali Mirjalili
    Department of Anatomy and Medical Imaging, The University of Auckland, Auckland, New Zealand

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<jats:p> The cisterna chyli is a lymphatic structure found at the caudal end of the thoracic duct that receives lymph draining from the abdominal and pelvic viscera and lower limbs. In addition to being an important landmark in retroperitoneal surgery, it is the key gateway for interventional radiology procedures targeting the thoracic duct. A detailed understanding of its anatomy is required to facilitate more accurate intervention, but an exhaustive summary is lacking. A systematic review was conducted, and 49 published human studies met the inclusion criteria. Studies included both healthy volunteers and patients and were not restricted by language or date. The detectability of the cisterna chyli is highly variable, ranging from 1.7 to 98%, depending on the study method and criteria used. Its anatomy is variable in terms of location (vertebral level of T10 to L3), size (ranging 2–32 mm in maximum diameter and 13–80 mm in maximum length), morphology, and tributaries. The size of the cisterna chyli increases in some disease states, though its utility as a marker of disease is uncertain. The anatomy of the cisterna chyli is highly variable, and it appears to increase in size in some disease states. The lack of well-defined criteria for the structure and the wide variation in reported detection rates prevent accurate estimation of its natural prevalence in humans. </jats:p>

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