CPT® Code 38794

The thoracic duct serves as the primary pathway for lymphatic fluid within the body, playing a crucial role in the lymphatic system. It originates from the cisterna chyli, located at the level of the second lumbar vertebra, and ascends through the abdominal region, positioned anteriorly to the vertebral bodies. As it progresses into the thoracic cavity, the thoracic duct traverses the aortic hiatus on the right side and subsequently crosses over to the left side at approximately the fourth or fifth thoracic vertebra. Ultimately, it drains lymphatic fluid into the left jugular-subclavian venous junction. The procedure of cannulation of the thoracic duct is indicated primarily to alleviate obstructions in lymphatic flow, which may occur due to external compression from malignant tumors or in patients suffering from cirrhosis, particularly when complicated by ascites and portal hypertension. During the procedure, a surgical incision is typically made above the clavicle to access the thoracic duct. Once exposed, the duct is punctured and cannulated, allowing for the advancement of the cannula as necessary. Post-cannulation, the lymphatic fluid is carefully monitored for its flow, pressure, and composition, which can provide valuable insights into the underlying causes of any obstruction present.