Celiac disease is caused by rupture or obstruction of the thoracic duct for different reasons, causing celiac fluid to overflow into the thoracic cavity. The thoracic duct is the largest lymphatic duct in the body, with a total length of about 30-40 cm. It originates from the celiac pond in front of the first lumbar vertebra in the abdominal cavity and travels upward through the aortic foramen through the diaphragm and into the mediastinum. It then travels upward along the right anterior side of the vertebral body and the posterior side of the esophagus and crosses the vertebral body at the fifth thoracic vertebrae obliquely to the left. It travels up the left side of the vertebral body and esophagus to the neck, crosses the subclavian artery posterior to the carotid sheath and returns and injects the left jugular vein at the left venous angle where the left jugular vein and left subclavian vein converge. I. Pathogenesis Celiac disease can be divided into congenital and traumatic medical origin, non-medical origin, spontaneous, two categories, with traumatic and medical origin injury more common. Pathogenesis When the thoracic duct is pressurized or blocked, the intraductal pressure increases, causing the duct or its branches in the mediastinum to rupture, and the celiac fluid refluxes and overflows into the mediastinum, and then penetrates the mediastinum into the thoracic cavity, forming celiac pleural effusion. It is also possible that due to high pressure of the thoracic duct, dilatation and reflux of intrapulmonary and intercostal lymphatic vessels occur, and celiac fluid leaks directly into the thoracic cavity without passing through the mediastinum. Due to anatomical reasons, when the obstruction or compression occurs below the fifth thoracic vertebra, only the right side of celiac disease appears, and when it occurs above the fifth thoracic vertebra, bilateral celiac disease appears. Third, what are the early symptoms of celiac disease? There are two parts, one is the manifestation of the primary disease; the other is the symptoms of celiac disease itself. Traumatic thoracic duct rupture and rapid spillage of celiac fluid can produce compression symptoms, such as shortness of breath, dyspnea, and mediastinal shift. Those caused by diseases are less symptomatic. Malnutrition may occur due to excessive loss of fat, protein and electrolytes, or immune deficiency due to excessive loss of T lymphocytes. Medical history 1. Rare causes such as history of chest surgery, closed chest injury, violent cough or vomiting, spinal hyperextension or fracture may also lead to thoracic duct tear. Kaposi’s sarcoma is often secondary to acquired immunodeficiency syndrome AIDS, which can lead to celiac disease. In a few congenital cases, the cause is malformation of thoracic duct development, such as dilatation, defect, atresia or fistula formation. Clinical manifestations There are two parts, one is the manifestation of the primary disease; the other is the symptoms of celiac disease itself. Traumatic rupture of the thoracic duct and rapid spillage of celiac fluid can produce symptoms of compression, such as shortness of breath, dyspnea, and mediastinal shift. Those caused by diseases are less symptomatic. Malnutrition may occur due to excessive loss of fat, protein and electrolytes, or immune deficiency due to excessive loss of T lymphocytes. Fourth, auxiliary examination includes: 1. Appearance of pleural effusion: 0.50 is milk-like, 0.12 is plasma-like or plasma-blood-like, with an oily film on the upper layer after placement, and remains turbid after centrifugal precipitation. 2, pleural effusion examination: pleural fluid triglyceride determination is often >2.75mmol/L and higher than plasma content, cholesterol/triglyceride 30g/L. The cell count is low, mainly lymphocytes [0.4-6.8×109/L], rare neutrophils, and bacterial culture is negative. Fat droplets were visible microscopically.