PECQUET OR QUILO CISTERN: WHAT IS IT, SYSTEM AND CIRCULATION - BIOLOGY - 2025

The tank chyli cistern or chyle is a dilated portion of the lymphatic system that acts as a reservoir of lymph, the liquid circulating in the vascular system. It is located in the abdomen and continues into the chest through the thoracic duct.

The lymphatic system is a part of the vascular system that is distributed parallel to the venous system. It is made up of an organized group of vessels and nodes that drain lymphatic fluid or lymph.

From Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See "Book" section below) Bartleby.com: Gray's Anatomy, Plate 599, Public Domain, https://commons.wikimedia.org/w/index. php? curid = 566545

Lymph is a clear liquid that comes from blood, it differs from it because it does not carry oxygen and contains only one cell group. The lymph circulates through the lymphatic vessels.

The lymphatic system is concerned with filtering and breaking down into smaller particles, elements that are too large to continue in the bloodstream. It has an important participation in the metabolism of fats and vitamins.

It is also responsible for absorbing the fluid that exudes from the blood capillaries and returns it to the venous circulation.

What is the Pecquet cistern?

Also called the chyle cistern, it was discovered in 1648 by Jean Pecquet (1622-1674), a French anatomist and physiologist who, through his experimental work and the dissection of animals, described the fluid and the lymphatic system, showing that it was a different from vascular system.

Pecquet conducted experiments for many years, which provided important data on the lymphatic system and the circulation of lymph through it.

The Pecquet cistern is not an element present in all human beings. When found, it is located at the level of the second lumbar vertebra and continues with the thoracic duct.

The thoracic duct or left lymphatic duct is a large lymphatic vessel that drains most of the lymphatic fluid from the body, except for the right hemithorax. This last portion is drained by the right lymphatic duct.

From Cancer Research UK - WIKIMEDIA COMMONSFile: Diagram showing the parts of the body the lymphatic and thoracic ducts drain CRUK 323.svg, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid= 74648148

The large lymphatic vessels contain valves that prevent fluid from flowing back, causing retrograde circulation and delaying proper lymphatic flow.

The left lymphatic duct ends its journey by draining at the junction of the left subclavian vein with the left internal jugular vein. The right lymphatic duct ends at the same level, reaching the venous circulation at the junction of the right subclavian and internal jugular veins.

Clinical significance

Injuries, both in the Pecquet's cistern and in the thoracic duct at any point, can have serious consequences.

Penetrating trauma from a gunshot or stab wound can cause fissures or complete sectioning of these lymphatic elements. This type of injury can also be seen during extensive abdominal surgeries, especially cardiovascular surgeries such as the aortic aneurysm. In many cases, these injuries go unnoticed.

A small fissure in the Pecquet's cistern can cause lymph leakage into the abdomen. If the amount of fluid does not exceed 25 cc, it can be incorporated into the peritoneal circulation without causing further damage.

On the contrary, a complete section of the chyle cistern or the thoracic duct in its abdominal portion can cause a large amount of fluid to leak into the abdomen, forming a condition called chylous ascites, which is nothing more than the accumulated lymphatic fluid. in the abdomen.

By Matani S, Pierce JR - https://www.ncbi.nlm.nih.gov/pubmed/26425641, CC BY 4.0, When there is injury to the left thoracic duct in its intrathoracic portion, lymphatic fluid accumulates within the pleural cavity, directly affecting the lungs. This condition is called chylothorax.

Contrary to chylous ascites, the chylothorax must always be drained since due to its location it does not have a reabsorption pathway and can cause respiratory complications.

The treatment of these pathologies consists of the drainage of the fluid and the design of a special diet with fat restriction, which prevents the formation of more lymphatic fluid. In severe cases it is necessary to cancel oral feeding and limit yourself to feeding the patient through the vein.

The intravenous or parenteral feeding allows a strict control of the fats and nutrients that enter the organism to reduce and, finally, stop the lymphatic effusion.

Lymphatic system

The lymphatic system is, together with the vascular system, one of the great circulatory systems of the body. It is made up of vessels and lymph nodes that carry a fluid called lymph.

Structure

The anatomy of the vessels that make up the lymphatic system is comparable to that of the vascular system, especially the venous one. In fact, the lymphatic circulation runs parallel to the venous one.

From Modified from Cancer Research UK - Modified from File: Diagram of the lymphatic system CRUK 041.svgWIKIMEDIA COMMONS, CC BY-SA 4.0, For their part, the lymph nodes are filtering stations where large particles such as lipids, proteins or bacteria are metabolized to enter the vascular system.

The lymphatic system differs from the vascular system because it does not have any organ comparable to the heart, that is, there is no muscular pump that mobilizes fluid through the vessels. Thus, lymphatic circulation occurs by contraction of the body's muscles and its own layer of smooth muscle, which contracts about 10 times per minute.

In addition to this, the lymphatic vessels carry lymph and not blood. Lymph is a clear liquid made up mainly of lipids or fats and white blood cells. It differs from blood because it does not contain hemoglobin, therefore it does not carry oxygen.

Features

The lymphatic system has three main functions:

- Defend the body against foreign particles and bacteria.

- Return the liquid expelled by the vascular capillaries to the blood circulation.

- Metabolize fats and vitamins from the intestine and return these metabolized elements to the venous circulation.

Lymphatic circulation

Lymphatic circulation begins in the millimetric lymphatic capillaries that are attached to the tissues and closely related to the blood capillaries.

These small vessels are composed of a permeable cellular layer, which receives the so-called interstitial fluid, which is nothing more than cellular fluid that does not reach the bloodstream. The lymphatic system is responsible for absorbing this fluid and returning it to the venous flow.

From Cancer Research UK - WIKIMEDIA COMMONSFile: Diagram of a lymphatic capillary CRUK 023.svg, CC BY-SA 4.0, From these capillaries a network of lymphatic vessels of ever greater diameter is formed, accompanying the vessels of the venous circulation and running parallel to them.

Two large lymphatic trunks called lumbar lymphatic vessels rise from the lower limbs. These end in the cistern or reservoir of Pecquet which is an enlarged portion that stores lymph.

References

1. Null, M; Agarwal, M. (2019). Anatomy, Lymphatic System. Treasure Island (FL): StatPearls. Taken from: ncbi.nlm.nih.gov
2. Moore, J. E; Bertram, CD (2018). Lymphatic System Flows. Annual review of fluid mechanics. Taken from: ncbi.nlm.nih.gov
3. Choi, I., Lee, S., & Hong, YK (2012). The new era of the lymphatic system: no longer secondary to the blood vascular system. Cold Spring Harbor perspectives in medicine. Taken from: ncbi.nlm.nih.gov
4. Cueni, LN, & Detmar, M. (2008). The lymphatic system in health and disease. Lymphatic research and biology. Taken from: ncbi.nlm.nih.gov
5. Olivar Roldán, J; Fernández Martínez, A; Martínez Sancho, E; Díaz Gómez, J; Martín Borge, V; Gómez Candela, C. (2009). Dietary treatment of postsurgical chylous ascites: clinical case and literature review. Hospital Nutrition. Taken from: scielo.isciii.es