During a right-sided thoracotomy for esophagectomy, the surgeon must identify and protect the thoracic duct. At which level does the thoracic duct cross from the right to the left side of the vertebral column?
- A At the level of T8-T9
- B At the level of T4-T5 ✓
- C At the level of T10-T11
- D At the level of L1-L2
Correct answer: B. At the level of T4-T5
Explanation
The thoracic duct ascends on the right side of the vertebral column from T12 (entering through the aortic opening of the diaphragm) up to T4-T5, where it crosses to the left side. Above T4-T5, the duct runs on the left. It eventually arches over the subclavian artery to drain into the left brachiocephalic vein (junction of left subclavian and internal jugular veins). This crossing explains why right-sided thoracotomies risk thoracic duct injury in its right-sided lower segment, while left-sided injuries occur in the upper segment.
Reference: BD Chaurasia's Human Anatomy, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.