THORACIC DUCT AND

AZYGUS SYSTEM OF VEINS

BY

DR KELECHI DURUH
HUMAN ANATOMY DEPT.
COLLEGE OF MEDICINE
UNEC
THORACIC DUCT
 THORACIC DUCT
INTRODUCTION
• Thoracic duct is the largest lymphatic vessel of
the body
• Courses through the posterior and superior
mediastinae
• Carries about 75% of body’s lymphatic flow
• Extends from cisterna chyli(T12) to the
confluence of left internal jugular and
subclavian veins(thoracic inlet)
 THORACIC DUCT
INTRODUCTION
• Carries lymph from lower limbs , abdomen,
posterior mediastinum, left intercoastal nodes, left
bronchomediastinal trunk, left upper limb and left
side of head and neck
• The right lymphatic duct drains the right intercostal
nodes, the right bronchomediastinal trunk ,right
upper limb and right side of head and neck.
 THORACIC DUCT

SCHEMATIC DIAGRAM OF LYMPHATIC DRAINAGE OF ABDOMEN AND CHEST

 THORACIC DUCT
COURSE
 Commences at upper end of cisterna chyli on the
level of T12 body.
 Lies between thoracic aorta and azygous vein
 Passes upward between the crurae of the
diaphragm
 From level T10-T6 lies against the right side of
the oesophagus
 At level of T5, passes behind the oesophagus
THORACIC DUCT

COURSE AND RELATION

 THORACIC DUCT
COURSE contd.
 In the posterior mediastinum, it lies anterior to the right
intercostal arteries and the terminal parts of the hemi-
and accessory azygous veins
 At the level of T4, in the superior mediastinum, lies to the
left of the oesophagus
 In the superior mediastinum , lies posterior to the arch
and the left subclavian artery
 At the root of the neck ,arches forwards to insert at the
confluence of left internal jugular and subclavian veins
 THORACIC DUCT
RELATIONS
 WITHIN THE POSTERIOR MEDIASTINUM
 LEFT: Thoracic aorta, oesophagus, right vagus nerve
 RIGHT: Azygus vein
 ANTERIOR: Posterior surface of pericardium,
oesophagus(T5)
 POSTERIOR: Right aortic intercostal arteries,
terminal parts of hemiazygus and accessory
hemiazygus veins
 THORACIC DUCT
RELATIONS contd.
 WITHIN THE SUPERIOR MEDIASTINUM
 ANTERIOR: Arch of aorta , left subclavian
artery, carotid sheath
 LEFT: Left pleura
 RIGHT: Oesophagus, left recurrent laryngeal
nerve
 THORACIC DUCT

RELATION WITH STRUCTURES IN THE SUPERIOR MEDIASTINUM

 THORACIC DUCT
CLINICAL CORRELATES
 Chylothorax: extravasations of contents of
the thoracic duct . Commonly caused by
penetrating injury
AZYGOUS SYSTEM OF VEINS
 INTRODUCTION
• The posterior thoracic wall and lumbar regions
are drained by the posterior intercostal and
lumbar veins into the azygus system of veins
• The components of the system are ,azygus
vein , hemiazygus vein and accessory
hemiazygus vein
 AZYGUS SYSTEM OF VEINS

SCHEMATIC DIAGRAM OF VEINOUS DRAINAGE OF POST. CHEST WALL

 AZYGUS VEIN
• Formed by the union of right ascending lumbar
vein and right subcostal vein
• Ascends through the aortic opening of
diaphragm
• Lateral to the thoracic duct
• Receives 5th -12th intercostal veins, bronchial
veins from right lung ,pericardial veins, some
veins from middle third of oesophagus ,
superior intercostal and the hemiazygus veins
 AZYGUS VEIN
• The two hemiazygus usually join the azygus
vein at level of T7 and T8
• At level of T4(in superior mediastinum),arches
forward over the hilum of right lung
• Inserts into the superior vena cava
AZYGOUS SYSTEM OF VEINS

VENOUS DRAINAGE OF POSTERIOR WALL OF THORAX

 HEMIAZYGUS VEINS
• In two parts, hemiazygus and accessory
hemiazygus veins
• Run longitudinally on the left sides of the
bodies of the lower eight thoracic vertebrae
• Usually drain separately into azygus vein but
may communicate
• Receives the left eight lower intercostal veins,
four for each
 HEMIAZYGUS VEINS
• Hemiazygus vein is formed by left ascending
lumbar vein and left subcostal vein
• Hemiazygus drains the lower four intercostals
and lower oesophagus
• Accessory hemiazygus drains the middle four
intercostals and bronchial veins of the left lung
 CLINICAL CORRELATES
• Oesophageal varices : Usually secondary to
portal hypertension. It is the engorgement of
the anastomotic vessels azygus veins at the
terminal oesophagus. May result to massive
bleeding
• Interrupted inferior vena cava: The inferior
vena cava does not develop well and the
azygus veins compensate
END