Anatomic Landmarks for the Cervical Portion of the Thoracic Duct

Abstract

Avoidance of injury to the thoracic duct during neurosurgical procedures involving the cervical region depends on a working knowledge of its location. This study evaluates superficial anatomic landmarks for the cervical portion of the thoracic duct that may be encountered in neurosurgery of the neck. Fifteen dissections of human cadavers were performed to study the relationship between the proximal thoracic duct and superficial landmarks (e.g., the cricoid cartilage and sternal notch of the manubrium). The cervical portion of the thoracic duct was found to be approximated by a roughly 4.4-cm² region in the left supraclavicular area beginning approximately 2.0 cm lateral to the midline and 3.5 cm superior to the sternal notch, extending superiorly to a point roughly 3.5 cm from the midline and 2.5 cm inferior to the cricoid cartilage, and terminating within the venous system at a point approximately 4.5 cm lateral to the midline and 3.0 cm superior to the sternal notch. Through an increased appreciation for its location, injury to the thoracic duct may be minimized.