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At the time the article was created Daniel J Bell had no recorded disclosures.View Daniel J Bell's current disclosures
At the time the article was last revised Craig Hacking had the following disclosures:
- Philips Australia, Paid speaker at Philips Spectral CT events (ongoing)
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The lumbar trunks (TA: truncus lumbalis) are paired lymphatic trunks that join to form the cisterna chyli, forming an integral part of the lymphatic system. The lumbar trunks carry lymph from the infraumbilical abdominal wall, pelvis and lower limbs 1,2. The intestinal trunk in the majority of people drains into the left lumbar trunk rather than directly into the cisterna chyli.
The left and right lumbar trunks course adjacent and parallel to the abdominal aorta and inferior vena cava. They sit anterior to the diaphragmatic crura, sympathetic chain and the medial border of psoas major.
The lumbar trunks ascend from the lateral aortic nodes, which themselves drain the: 5
- deep layers of the infraumbilical abdominal wall
- paired retroperitoneal viscera of the abdomen (kidneys and adrenal glands)
- pelvic walls and viscera (including the gonads)
- efferents from the common Iliac nodes draining the lower limbs
The lumbar trunks terminate directly or indirectly in the cisterna chyli.
The precise tributaries that form the cisterna chyli exhibit a considerable array of anatomic variance. The left lumbar trunk more commonly drains directly into the cisterna chyli than does the right lumbar trunk 5,6.
The lumbar lymphatic trunks may be seen on abdominal CT but could only be confidently identified in ~5% patients 4. However this is a very old study and with a modern CT it is probably easier to visualize these structures.
The left and right lumbar trunks can be seen in the majority of individuals on heavily T2-weighted MRI (e.g. MRCP-type sequences) as they ascend along the left and right paravertebral gutters. In a study of 125 patients specifically looking for these structures retrospectively on MRCP they were confidently identified in 70% cases 1.
- 1. Erden A, Fitoz S, Yagmurlu B, Erden I. Abdominal confluence of lymph trunks: detectability and morphology on heavily T2-weighted images. (2005) AJR. American journal of roentgenology. 184 (1): 35-40. doi:10.2214/ajr.184.1.01840035 - Pubmed
- 2. Skandalakis JE, Skandalakis LJ, Skandalakis PN. Anatomy of the lymphatics. (2007) Surgical oncology clinics of North America. 16 (1): 1-16. doi:10.1016/j.soc.2006.10.006 - Pubmed
- 3. Loukas M, Wartmann CT, Louis RG, Tubbs RS, Salter EG, Gupta AA, Curry B. Cisterna chyli: a detailed anatomic investigation. (2007) Clinical anatomy (New York, N.Y.). 20 (6): 683-8. doi:10.1002/ca.20485 - Pubmed
- 4. Williams MP, Featherstone T, Cook JV. CT of lumbar lymph trunks. (1989) Clinical radiology. 40 (6): 653-4. doi:10.1016/s0009-9260(89)80417-9 - Pubmed
- 5. Susan Standring. Gray's Anatomy. (2015) ISBN: 9780702052309
- 6. R. Shane Tubbs, Mohammadali M. Shoja, Marios Loukas. Bergman's Comprehensive Encyclopedia of Human Anatomic Variation. (2016) ISBN: 9781118430354