Syntopy of the thoracic lymphatic duct in the area of the left venous angle of the neck in terms of its use in anesthesiological practice. Puncture catheterization of the inferior vena cava and the mouth of the hepatic veins Venous angle of Pirogov
Pirogov venous angle (N.I. Pirogov)
1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First medical care. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary medical terms. - M.: Soviet Encyclopedia. - 1982-1984.
See what “Pirogov venous angle” is in other dictionaries:
- (N.I. Pirogov) see Venous angle... Large medical dictionary
Large medical dictionary
- (angulus venosus; synonym Pirogov venous angle) the confluence of the subclavian and internal jugular veins, forming the brachiocephalic vein ... Medical encyclopedia
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TOPOGRAPHY OF THE STAIMOVERTEBRAL SPACE
Behind the lower part of the sternocleidomastoid muscle there are deep intermuscular spaces of the neck:
The prescalene space, bounded posteriorly by the anterior scalene muscle, and anteriorly by mm. sternotyreoideus and. sternohyoideus. It contains the inferior bulb of the internal jugular vein, the common carotid artery, vagus nerve, the confluence of the subclavian and internal jugular veins (venous angle of Pirogov). The thoracic lymphatic duct flows into the left one, and the right lymphatic duct flows into the right one), the phrenic nerve.
The scalene-vertebral interval, the boundaries of which are: outside - the anterior scalene muscle, inside - the length of the neck muscle, below - the dome of the pleura, above - the carotid tubercle of the transverse process of the VI cervical vertebra. It contains the initial section of the subclavian artery, the arch of the thoracic lymphatic duct, the middle, intermediate and lower nodes of the sympathetic trunk.
The interscalene space is located between the anterior and middle scalene muscles. It contains the middle section of the subclavian artery.
In these spaces, the following depart from the subclavian artery:
Internal thoracic artery;
Vertebral artery;
Thyrocervical trunk (inferior thyroid artery, ascending cervical artery, superficial cervical artery and suprascapular artery);
Costocervical trunk (deep neck artery, highest thoracic artery);
Transverse artery of the neck).
Scalenovertebral triangle
The base of this triangle is the dome of the pleura, and the apex is the transverse process of the VI cervical vertebra; The inner border is formed by the spine with the longus colli muscle, and the outer 4th by the anterior scalene muscle. The medial section of the subclavian artery lies on the dome of the pleura.
The anterior scalene and longus colli muscles diverge from the apex of the triangle. Between them, under the prevertebral (fifth) fascia, which forms the sheaths of these muscles, there are the sympathetic trunk, its cervicothoracic (stellate) node, branches extending from the medial section of the subclavian artery, and on the left side also the thoracic lymphatic duct.
External part the lower part of the sternocleidomastoid muscle participates in the formation of the anterior wall of the prescalene space, spatium antescalenum, limited behind by the anterior scalene muscle with the phrenic nerve on it. In this gap, in the depth between the scapuloclavicular and prevertebral fascia of the neck, the medial neurovascular bundle lies most inward, enclosed in the vagina formed by the parietal layer of the intracervical (fourth) fascia.
After dissection of the scapuloclavicular fascia together with the lower belly of the omohyoid muscle, the internal jugular vein, located outward and more superficially, and its lower extension(bulb), bulbus venae jugularis inferior, at the confluence with the subclavian vein.
Immediately outside the junction of these veins, called the Pirogov venous angle, the external jugular vein, vena jugularis externa, flows into the subclavian vein.
The thoracic lymphatic duct, ductus thoracicus, is located on the left side of the neck. It first ascends the posterior wall of the esophagus and then passes between the internal jugular vein in front and the vertebral vein in the back.
At the outer edge of the internal jugular vein cervical region The ductus thoracicus forms an arch into which the left jugular and left subclavian lymphatic trunks flow. Then the descending part of the arch of the thoracic duct goes anterior to the subclavian artery and sometimes, dividing into 2-3 trunks, flows into the Pirogov venous angle from behind.
On right side of the neck, the right lymphatic duct, ductus lymphaticus dexter, flows into the venous angle, which is formed from the fusion of the right jugular, subclavian and bronchomediastinal lymphatic trunks located at back wall internal jugular vein. In the absence of the right lymphatic duct, they flow into the subclavian vein or into the Pirogov's venous angle separately.
The subclavian artery is projected to the middle of the upper edge of the clavicle. In the angle formed by the upper edge of the clavicle and the sternal pedicle m. sternocleidomastoid, projected on the right - the brachiocephalic trunk, on the left - the common carotid artery. The Pirogov venous angle, as well as the vagus (medially) and phrenic (lateral) nerves are projected between the legs of this muscle.
Right subclavian artery, a. subclaviadextra, extends from the brachiocephalic trunk, and the left, a. subclavia sinistra, - from the aortic arch.
The subclavian artery is conventionally divided into 4 sections:
· the first - from the beginning to the inner edge of the anterior scalene muscle, it contains an intra- and extrathoracic area;
· the second occupies the interscalene space, spatium interscalenum;
· third - supraclavicular section - from the outer edge of the anterior scalene muscle to the clavicle;
fourth - from the collarbone to the upper edge of the small pectoral muscle. The last section of the subclavian artery is often referred to as the axillary artery and is studied in the subclavian region, in the clavipectoral triangle, trigonum clavipectorale.
Table of contents of the topic "Topography of the sternocleidomastoid region. Topography of the prescalene space. Topography of the subclavian artery. Topography of the lateral region of the neck.":1.
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Prescaler space. Topography of the prescalene space. Venous angle of Pirogov. Vessels of the prescalene space. Nerves of the prescalene space.
Between the deep (posterior) surface of the lower half of the sternocleidomastoid muscle with its fascial sheath and the anterior scalene muscle, covered with the 5th fascia, a prescaler space, spatium antescalenum.
Its anterior wall also includes the pretracheal plate of the fascia of the neck (3rd fascia). Thus, prescaler space anteriorly it is limited by the 2nd and 3rd fascia, and posteriorly by the 5th fascia of the neck.
The carotid neurovascular bundle is located medially. The internal jugular vein lies in the prescalene space not only lateral to the common carotid artery, but also somewhat anterior (superficial).
In the pre-scalene space its bulb (lower extension), bulbus venae jugularis inferior, connects with the subclavian vein approaching from the outside. The vein is separated from the subclavian artery by the anterior scalene muscle.
Venous angle of Pirogov
Immediately outward from the confluence of these veins, called Pirogovsky venous angle, the external jugular vein flows into the subclavian vein. On the left, the thoracic (lymphatic) duct flows into the venous angle. United v. jugularis interna and v. subclavia give rise to the brachiocephalic vein. The suprascapular artery, a suprascapularis, also passes through the prescalene interval in the transverse direction.
Thus, in the prescaler space located are the carotid neurovascular bundle, subclavian vein, thoracic duct (on the left), external jugular vein and suprascapular artery. Here, on the anterior surface of the anterior scalene muscle, the p. phrenicus muscle is visible, but it already lies under the 5th fascia.
(N.I. Pirogov) see Venous angle.
View value Pirogov Venous Angle in other dictionaries
Venous- venous, venous (anat.). Adj. to vein. Venous blood.
Ushakov's Explanatory Dictionary
Corner- m. fracture, kink, knee, elbow, protrusion or crease (depression) on one side. linear, any two opposing features and their interval; angle plane or in planes, meeting........
Dahl's Explanatory Dictionary
Corner- angle, about the angle, on (in) the corner and (mat.) in the corner, m. 1. Part of the plane between two straight lines emanating from one point (mat.). Top of the corner. Sides of the corner. Measuring an angle in degrees.........
Ushakov's Explanatory Dictionary
Venous Adj.— 1. Correlative in meaning. with noun: vein, connected with it. 2. Characteristic of the vein, characteristic of it.
Explanatory Dictionary by Efremova
Venous— see Vienna.
Kuznetsov's Explanatory Dictionary
Subdue the Market, Arrange a Corner on the Market (corner - Corner - Speculative Control of the Market)— Purchase securities in sufficient time large quantities in order to be able to control their prices. Subordination of the market for certain securities........
Economic dictionary
Corner- (slang) - monopolistic behavior of a company, consisting of controlling
total volume
offers
goods;
the price may rise until the appearance of........
Economic dictionary
Comer ("angle", Corner)- A monopoly that is established by an organization that succeeds in controlling the volume of total supply of a good or service (often called speculative......
Economic dictionary
Corner- angle, sentence about coal, in the corner, (math.) in the coal; m.
1. Math. The part of the plane between two straight lines emanating from the same point. Angle measurement. Direct y. (equal........
Kuznetsov's Explanatory Dictionary
Corner- Common Slavic word of Indo-European nature. In Latin we find angulus (“angle”), in Greek agkylos (“crooked”), in English angle (“angle”), etc.
Krylov's etymological dictionary
Corner- (slang) - monopolistic behavior of the company, consisting in controlling the volume of the total supply of goods; the price may rise until it appears on the market........
Legal dictionary
Critical Angle- , the angle at which a noticeable change occurs in any process. For example, in optics this is the ANGLE OF INCIDENCE in a medium in which total internal REFLECTION occurs.........
Solid angle- , spatial angle formed at the center of the sphere by the TOP OF A CONE, the base of which is located on the surface of the sphere. Solid angles are measured in steradians and defined........
Scientific and technical encyclopedic dictionary
Corner- , a measure of the inclination between two straight lines or planes, as well as the amount of rotational motion. A complete circle is divided into 360° (degrees) or 2p radians. Right angle........
Scientific and technical encyclopedic dictionary
Reflection Angle— , in optics, the angle at which a beam of light departs from a reflective surface. The angle is measured between the ray and the perpendicular - a line located at right angles to the surface........
Scientific and technical encyclopedic dictionary
Incidence Angle— , in optics, the angle at which a beam of light falls on a mirror or other surface. The angle is measured between the ray and the perpendicular - a line located at right angles........
Scientific and technical encyclopedic dictionary
Refraction Angle— , in optics, the angle at which a ray of light is refracted from the interface between two different transparent media. The angle is measured between the refracted........
Scientific and technical encyclopedic dictionary
External Corner— triangle (polygon) - an angle formed by one of its sides and the continuation of the adjacent side.
Inscribed Angle- the angle formed by two chords (CA and CB) emanating from the isode point (C) of the circle.
Large encyclopedic dictionary
Dihedral angle- a figure formed by two half-planes (faces of a dihedral angle) emanating from one straight line, called an edge of a dihedral angle. measured by linear angle, t.........
Large encyclopedic dictionary
Directional Angle- between the northern direction of a straight line parallel to the abscissa in a system of rectangular coordinates on a plane (projection, topographic map), and the direction to a given .......
Large encyclopedic dictionary
Polyhedral Angle— see Solid angle.
Large encyclopedic dictionary
Acute angle- an angle less than a right angle.
Large encyclopedic dictionary
Right angle- an angle equal to its adjacent one.
Large encyclopedic dictionary
Straight Angle- an angle equal to two straight lines.
Large encyclopedic dictionary
Solid angle- a part of space limited by a certain conical surface, in particular, trihedral and polyhedral angles are limited, respectively, by three and many flat ones.......
Large encyclopedic dictionary
Triangular Angle— see Solid angle.
Large encyclopedic dictionary
Obtuse angle- an angle greater than a right angle and less than a straight angle.
Large encyclopedic dictionary
Corner- (flat) - geometric figure, formed by two rays (sides of an angle) emerging from one point (vertex of an angle). Every angle with its apex at the center of a circle........
Large encyclopedic dictionary
Angle of Attack- the angle between the direction of the speed of movement of the body and the direction selected on the body, for example. at the wing - the chord of the wing, at the projectile, rocket, etc. - the axis of symmetry.
Large encyclopedic dictionary
G.I. Songolov, O.P. Galeeva, V.P. Shevtsov
State Medical University, Irkutsk
Resume
The material on the syntopy of the cervical thoracic lymphatic duct with regard to its use for detoxification in cholangitis, pancreatitis, and peritonitis has been systematized. Variants of the structure and relationship of the thoracic lymphatic duct with the anatomical formations of the left venous angle of Pirogov, including the lymph nodes and the left stellate node, were identified. A clear knowledge of the features of the relationship between these structures will improve the efficiency and reliability of drainage and reduce the risk of intraoperative damage.
In resuscitation practice, drainage of the thoracic lymphatic duct is widely used to detoxify the body in various pathological conditions. The study was undertaken with the aim of topographic-anatomical substantiation of effective and safe lymphosorption. In the literature, there are reports of damage to the thoracic lymphatic duct in a number of other surgical procedures, including anesthetic ones. The implementation and successful completion of many operations on organs and formations of the neck requires the surgeon to have a clear understanding of topographical features, taking into account the options for the entry of the thoracic lymphatic duct into the venous system.
Material and methods
The work was performed on 50 fresh corpses of both sexes aged from 21 to 83 years. We used a universal method of anatomical preparation, followed by sketching using glass photography and making dioptrograms. Macropreparations of the venous angle with the arch of the thoracic lymphatic duct and lymph nodes were prepared. Stereotopometric and reconstructive methods were also used.
Results and discussion
We see the purpose of the message not in presenting comprehensive information about the thoracic lymphatic duct in the anatomical aspect, but in highlighting those issues that are of clinical importance. The venous angle of the neck (Pirogov's angle) is located behind the sternocleidomastoid muscle in the prescalene cellular space in the vascular sheath formed by the 4th fascia of the neck. In the area of the venous angle, many venous collectors flow into and their syntopy is extremely complex, which makes it difficult to identify the elements of this zone during operations. Thus, the thoracic lymphatic duct, coming from the left scalene-vertebral triangle, the external jugular vein, piercing successively from the outside of the 2nd and 3rd fascia of the neck, the vertebral vein, following from behind to the front through the 5th fascia, and also The transverse and suprascapular veins passing from the interscalene space of the lateral triangle of the neck.
Cervical thoracic duct above the superior aperture chest forms a lymphatic arch, convex upward and running in a layer of loose paravasal tissue. From the space between the left common carotid and subclavian arteries, the duct follows laterally into the space between the vertebral artery behind and the internal jugular vein in front and, having formed an extension - the lymphatic sinus, flows into the left venous angle. We noted various variants of the structure and flow of the terminal section of the thoracic lymphatic duct into the venous angle and the veins that form it. Individual anatomical variability of the studied structures was manifested as follows: by the place of confluence, by the number of orifices, by the height of the position of the arch and its sitopia with deep cervical lymph nodes.
- At the place of confluence. The thoracic lymphatic duct flows directly into the venous angle (30 observations), into the subclavian vein (14 observations), and into the internal jugular vein (6 observations).
- By the number of mouths. The thoracic lymphatic duct opens with one trunk (35 observations), two branches (8 observations), three branches (5 observations) and four (2 cases). With the mongorous confluence, lymph enters both the venous angle itself and the veins that form it. This is of clinical importance, since with this form the likelihood of damage to the duct is higher and in this case there is a need to ligate all branches to prevent lymphorrhea.
According to the height of the position. We distinguish a high position of the thoracic lymphatic duct - 1 cm above the upper contour of the brachiocephalic vein (level of the V cervical vertebra), typical - up to 1 cm (level of the VI cervical vertebra), low - at the level or below the upper edge of the same vein (level of the VII cervical vertebra ). We attribute the low position of the arc of the thoracic lymphatic duct to closed variants of its syntopy. It is difficult to find, identify and drain the duct, but at the same time it “saves” the duct when removing deep cervical lymph nodes for laryngeal cancer. All other options should be considered open. From these observations, we derived the following syntopy of the thoracic lymphatic duct and lymph nodes. Most often, 2 to 4 deep cervical lymph nodes, which are connected to it by collectors with a length of 3 to 6 mm and a diameter of up to 1 mm. In the relationship between the lymph nodes and the thoracic lymphatic duct, we distinguish 4 options: 1) the nodes are located only in front of the duct - 11 cases; 2) only behind the duct - 9 cases; 3) only above the arc - 16 cases; 4) mixed - 14 cases. Lymph nodes are concentrated mainly along the descending limb of the thoracic lymphatic duct arch.
The arc of the thoracic lymphatic duct is located differently in relation to the left stellate node. It is located above it (36 cases), below it (5 cases), laterally (8 cases). In one case, the branches of the sympathetic cervical trunk wrapped around the arch in a loop. In addition, situations should be identified when lymphatic ducts autonomously flow into the venous angle, draining certain regional areas of the head, neck and chest. Thus, a clear knowledge of the features of the architectonics and topography of the thoracic lymphatic duct will reduce the risk of intraoperative damage to the latter.
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