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Cisterna Chyli at Routine Abdominal MR Imaging: A Normal Anatomic Structure in the Retrocrural Space¹

¹ From the Department of Radiology, UCSD Medical Center, 200 W Arbor Dr, San Diego, CA 92103-8756 (P.S.P., C.B.S., O.A.A.B., M.A.B., R.F.M.); and Department of Radiology, Stanford University, Palo Alto, Calif (R.E.M.). Recipient of a Certificate of Merit award for an education exhibit at the 2002 RSNA scientific assembly. Received March 31, 2003; revision requested May 12 and received June 30; accepted July 1. Address correspondence to C.B.S. (e-mail: csirlin@ucsd.edu).

View larger version (189K): [in a new window]   Figure 1.  Photograph of a preserved cadaveric specimen shows a large cisterna chyli (arrow) anterior to the L1 vertebra and the proximal thoracic duct (arrowhead), afferent trunks that join with the inferior part of the cisterna, and intrathoracic tributaries of the thoracic duct. (Courtesy of Professor Roger Saban, Institut d’Anatomie des Saints Pères, Paris, France)

View larger version (140K): [in a new window]   Figure 2a.  Single straight thin tube. (a) Coronal T2-weighted MR image acquired with a HASTE sequence shows a small cisterna chyli as a single straight thin tube (arrow) between the aorta (*) and the right hemidiaphragmatic crus (arrowhead). The thoracic duct is not seen. (b) MIP image, reconstructed by using several coronal sections from the same HASTE sequence, depicts the cisterna (arrow) and one of the lumbar or intestinal afferent trunks (arrowhead).

View larger version (127K): [in a new window]   Figure 2b.  Single straight thin tube. (a) Coronal T2-weighted MR image acquired with a HASTE sequence shows a small cisterna chyli as a single straight thin tube (arrow) between the aorta (*) and the right hemidiaphragmatic crus (arrowhead). The thoracic duct is not seen. (b) MIP image, reconstructed by using several coronal sections from the same HASTE sequence, depicts the cisterna (arrow) and one of the lumbar or intestinal afferent trunks (arrowhead).

View larger version (187K): [in a new window]   Figure 3a.  Single straight thick tube. (a, b) Axial CT images of the retrocrural space, obtained before (a) and during (b) intravenous contrast material enhancement, show the cisterna chyli as a nonenhanced rounded structure (arrow) with the attenuation of fluid—an appearance that could result in its being mistaken for an enlarged retrocrural lymph node. (c) Coronal reformatted CT image shows the thick tubular cisterna between the right hemidiaphragmatic crus (arrowhead) and the aorta (*). (d, e) In the same patient, axial 2.5-mm-thick T1-weighted three-dimensional volume-interpolated breath-hold MR images obtained before (d) and approximately 60 seconds after (e) intravenous administration of a gadolinium compound show a low-signal-intensity structure (arrows), which did not enhance either in the arterial or the equilibrium phase (not shown). (f) Coronal HASTE image, obtained at the same MR imaging examination as d and e, depicts the cisterna chyli as a thick tubular structure (arrow). No size change was observed in this structure on 4- or 7-month follow-up images. Note the multiple hyperintense subcentimeter foci throughout the liver, which indicated von Meyenburg complex (bile duct hamartomas) in this patient.

View larger version (191K): [in a new window]   Figure 3b.  Single straight thick tube. (a, b) Axial CT images of the retrocrural space, obtained before (a) and during (b) intravenous contrast material enhancement, show the cisterna chyli as a nonenhanced rounded structure (arrow) with the attenuation of fluid—an appearance that could result in its being mistaken for an enlarged retrocrural lymph node. (c) Coronal reformatted CT image shows the thick tubular cisterna between the right hemidiaphragmatic crus (arrowhead) and the aorta (*). (d, e) In the same patient, axial 2.5-mm-thick T1-weighted three-dimensional volume-interpolated breath-hold MR images obtained before (d) and approximately 60 seconds after (e) intravenous administration of a gadolinium compound show a low-signal-intensity structure (arrows), which did not enhance either in the arterial or the equilibrium phase (not shown). (f) Coronal HASTE image, obtained at the same MR imaging examination as d and e, depicts the cisterna chyli as a thick tubular structure (arrow). No size change was observed in this structure on 4- or 7-month follow-up images. Note the multiple hyperintense subcentimeter foci throughout the liver, which indicated von Meyenburg complex (bile duct hamartomas) in this patient.

View larger version (165K): [in a new window]   Figure 3c.  Single straight thick tube. (a, b) Axial CT images of the retrocrural space, obtained before (a) and during (b) intravenous contrast material enhancement, show the cisterna chyli as a nonenhanced rounded structure (arrow) with the attenuation of fluid—an appearance that could result in its being mistaken for an enlarged retrocrural lymph node. (c) Coronal reformatted CT image shows the thick tubular cisterna between the right hemidiaphragmatic crus (arrowhead) and the aorta (*). (d, e) In the same patient, axial 2.5-mm-thick T1-weighted three-dimensional volume-interpolated breath-hold MR images obtained before (d) and approximately 60 seconds after (e) intravenous administration of a gadolinium compound show a low-signal-intensity structure (arrows), which did not enhance either in the arterial or the equilibrium phase (not shown). (f) Coronal HASTE image, obtained at the same MR imaging examination as d and e, depicts the cisterna chyli as a thick tubular structure (arrow). No size change was observed in this structure on 4- or 7-month follow-up images. Note the multiple hyperintense subcentimeter foci throughout the liver, which indicated von Meyenburg complex (bile duct hamartomas) in this patient.

View larger version (148K): [in a new window]   Figure 3d.  Single straight thick tube. (a, b) Axial CT images of the retrocrural space, obtained before (a) and during (b) intravenous contrast material enhancement, show the cisterna chyli as a nonenhanced rounded structure (arrow) with the attenuation of fluid—an appearance that could result in its being mistaken for an enlarged retrocrural lymph node. (c) Coronal reformatted CT image shows the thick tubular cisterna between the right hemidiaphragmatic crus (arrowhead) and the aorta (*). (d, e) In the same patient, axial 2.5-mm-thick T1-weighted three-dimensional volume-interpolated breath-hold MR images obtained before (d) and approximately 60 seconds after (e) intravenous administration of a gadolinium compound show a low-signal-intensity structure (arrows), which did not enhance either in the arterial or the equilibrium phase (not shown). (f) Coronal HASTE image, obtained at the same MR imaging examination as d and e, depicts the cisterna chyli as a thick tubular structure (arrow). No size change was observed in this structure on 4- or 7-month follow-up images. Note the multiple hyperintense subcentimeter foci throughout the liver, which indicated von Meyenburg complex (bile duct hamartomas) in this patient.

View larger version (159K): [in a new window]   Figure 3e.  Single straight thick tube. (a, b) Axial CT images of the retrocrural space, obtained before (a) and during (b) intravenous contrast material enhancement, show the cisterna chyli as a nonenhanced rounded structure (arrow) with the attenuation of fluid—an appearance that could result in its being mistaken for an enlarged retrocrural lymph node. (c) Coronal reformatted CT image shows the thick tubular cisterna between the right hemidiaphragmatic crus (arrowhead) and the aorta (*). (d, e) In the same patient, axial 2.5-mm-thick T1-weighted three-dimensional volume-interpolated breath-hold MR images obtained before (d) and approximately 60 seconds after (e) intravenous administration of a gadolinium compound show a low-signal-intensity structure (arrows), which did not enhance either in the arterial or the equilibrium phase (not shown). (f) Coronal HASTE image, obtained at the same MR imaging examination as d and e, depicts the cisterna chyli as a thick tubular structure (arrow). No size change was observed in this structure on 4- or 7-month follow-up images. Note the multiple hyperintense subcentimeter foci throughout the liver, which indicated von Meyenburg complex (bile duct hamartomas) in this patient.

View larger version (147K): [in a new window]   Figure 3f.  Single straight thick tube. (a, b) Axial CT images of the retrocrural space, obtained before (a) and during (b) intravenous contrast material enhancement, show the cisterna chyli as a nonenhanced rounded structure (arrow) with the attenuation of fluid—an appearance that could result in its being mistaken for an enlarged retrocrural lymph node. (c) Coronal reformatted CT image shows the thick tubular cisterna between the right hemidiaphragmatic crus (arrowhead) and the aorta (*). (d, e) In the same patient, axial 2.5-mm-thick T1-weighted three-dimensional volume-interpolated breath-hold MR images obtained before (d) and approximately 60 seconds after (e) intravenous administration of a gadolinium compound show a low-signal-intensity structure (arrows), which did not enhance either in the arterial or the equilibrium phase (not shown). (f) Coronal HASTE image, obtained at the same MR imaging examination as d and e, depicts the cisterna chyli as a thick tubular structure (arrow). No size change was observed in this structure on 4- or 7-month follow-up images. Note the multiple hyperintense subcentimeter foci throughout the liver, which indicated von Meyenburg complex (bile duct hamartomas) in this patient.

View larger version (170K): [in a new window]   Figure 4a.  Single sausage-shaped tube. (a) Axial nonenhanced CT image through the lower retrocrural space shows a structure with the attenuation of fluid posterior to the aorta (arrow). (b, c) Axial (b) and coronal (c) MR images obtained with a HASTE sequence show a sausage-shaped fluid-signal-intensity cisterna chyli (arrow). The meshwork of tiny lymphatic channels on both sides of the cisterna (arrowheads in c) represents the lumbar lymphatics.

View larger version (155K): [in a new window]   Figure 4b.  Single sausage-shaped tube. (a) Axial nonenhanced CT image through the lower retrocrural space shows a structure with the attenuation of fluid posterior to the aorta (arrow). (b, c) Axial (b) and coronal (c) MR images obtained with a HASTE sequence show a sausage-shaped fluid-signal-intensity cisterna chyli (arrow). The meshwork of tiny lymphatic channels on both sides of the cisterna (arrowheads in c) represents the lumbar lymphatics.

View larger version (144K): [in a new window]   Figure 4c.  Single sausage-shaped tube. (a) Axial nonenhanced CT image through the lower retrocrural space shows a structure with the attenuation of fluid posterior to the aorta (arrow). (b, c) Axial (b) and coronal (c) MR images obtained with a HASTE sequence show a sausage-shaped fluid-signal-intensity cisterna chyli (arrow). The meshwork of tiny lymphatic channels on both sides of the cisterna (arrowheads in c) represents the lumbar lymphatics.

View larger version (137K): [in a new window]   Figure 5.  Parallel tubes. Coronal HASTE image obtained in another patient depicts the cisterna chyli as two parallel sausage-shaped tubes (arrow).

View larger version (147K): [in a new window]   Figure 6a.  Tortuous tubes. (a) Coronal HASTE image through the retrocrural space shows two tortuous tubes, one on each side of the aorta (arrows), rather than a single cisterna chyli. (b) MIP image, reconstructed from several sections obtained with the same HASTE sequence, depicts the extent of the tubes and the continuation of the right tube as a tortuous thoracic duct (arrowhead).

View larger version (144K): [in a new window]   Figure 6b.  Tortuous tubes. (a) Coronal HASTE image through the retrocrural space shows two tortuous tubes, one on each side of the aorta (arrows), rather than a single cisterna chyli. (b) MIP image, reconstructed from several sections obtained with the same HASTE sequence, depicts the extent of the tubes and the continuation of the right tube as a tortuous thoracic duct (arrowhead).

View larger version (160K): [in a new window]   Figure 7a.  Focal collection. (a, b) Axial CT images through the retrocrural space, obtained before (a) and during (b) intravenous contrast enhancement, show a low-attenuating nonenhanced oval structure (arrow) in the retrocrural space. (c) Coronal MR image obtained with a HASTE sequence in the same patient depicts the cisterna chyli (arrowhead) as a focal (not tubelike) collection with the signal intensity of fluid.

View larger version (175K): [in a new window]   Figure 7b.  Focal collection. (a, b) Axial CT images through the retrocrural space, obtained before (a) and during (b) intravenous contrast enhancement, show a low-attenuating nonenhanced oval structure (arrow) in the retrocrural space. (c) Coronal MR image obtained with a HASTE sequence in the same patient depicts the cisterna chyli (arrowhead) as a focal (not tubelike) collection with the signal intensity of fluid.

View larger version (146K): [in a new window]   Figure 7c.  Focal collection. (a, b) Axial CT images through the retrocrural space, obtained before (a) and during (b) intravenous contrast enhancement, show a low-attenuating nonenhanced oval structure (arrow) in the retrocrural space. (c) Coronal MR image obtained with a HASTE sequence in the same patient depicts the cisterna chyli (arrowhead) as a focal (not tubelike) collection with the signal intensity of fluid.

View larger version (132K): [in a new window]   Figure 8.  Focal plexus. Coronal MIP image reconstructed from image data obtained with a HASTE sequence depicts the confluence of the left and right lymphatic trunks (arrows) as a focal plexus that continues upward as the thoracic duct (arrowhead).

View larger version (133K): [in a new window]   Figure 9a.  Coronal HASTE (a) and MIP (b) images show a thoracic duct (thick arrow) that courses up the right side of the aorta from its origin at the cisterna chyli, which appears as a focus of dilatation (thin arrow) in the retrocrural space. Two tubes adjacent to the lower aspect of the cisterna (arrowheads in a) represent two of the afferent trunks.

View larger version (135K): [in a new window]   Figure 9b.  Coronal HASTE (a) and MIP (b) images show a thoracic duct (thick arrow) that courses up the right side of the aorta from its origin at the cisterna chyli, which appears as a focus of dilatation (thin arrow) in the retrocrural space. Two tubes adjacent to the lower aspect of the cisterna (arrowheads in a) represent two of the afferent trunks.

View larger version (148K): [in a new window]   Figure 10a.  Coronal HASTE images obtained in two different patients show the meshwork of lumbar lymphatics (arrows). In a, the proximal thoracic duct is well depicted (arrowhead) and is seen to be supplied by several afferent trunks, rather than by a single distinct cisterna chyli.

View larger version (145K): [in a new window]   Figure 10b.  Coronal HASTE images obtained in two different patients show the meshwork of lumbar lymphatics (arrows). In a, the proximal thoracic duct is well depicted (arrowhead) and is seen to be supplied by several afferent trunks, rather than by a single distinct cisterna chyli.

View larger version (135K): [in a new window]   Figure 11a.  Coronal HASTE image (a) and MIP image (b) show an irregularly shaped cisterna chyli (arrow in b), as well as a delicate meshwork of tiny lymphatics (arrowheads), in the lumbar region inferior to the cisterna, seen more clearly in b.

View larger version (139K): [in a new window]   Figure 11b.  Coronal HASTE image (a) and MIP image (b) show an irregularly shaped cisterna chyli (arrow in b), as well as a delicate meshwork of tiny lymphatics (arrowheads), in the lumbar region inferior to the cisterna, seen more clearly in b.

View larger version (134K): [in a new window]   Figure 12a.  Coronal (a) and axial (b) HASTE images show a well-defined oblong postoperative fluid collection (thin arrow) in a patient 6 days after liver transplantation. In a, the fluid collection, because of its location between the aorta (*) and inferior vena cava (thick arrow), might be mistaken for the cisterna chyli. The axial image (b), however, clearly shows a location anterior to the right hemidiaphragmatic crus (arrowhead) and surrounding the vena cava, inconsistent with the location of the cisterna chyli.

View larger version (143K): [in a new window]   Figure 12b.  Coronal (a) and axial (b) HASTE images show a well-defined oblong postoperative fluid collection (thin arrow) in a patient 6 days after liver transplantation. In a, the fluid collection, because of its location between the aorta (*) and inferior vena cava (thick arrow), might be mistaken for the cisterna chyli. The axial image (b), however, clearly shows a location anterior to the right hemidiaphragmatic crus (arrowhead) and surrounding the vena cava, inconsistent with the location of the cisterna chyli.