3-year-old boy, one day post-op after repair of a congenital diaphragmatic hernia. He becomes tachypneic and hypoxic: RR 40, HR 130, BP 90/60, SpO2 88% on room air. Chest X-ray shows a pleural effusion. Thoracentesis returns milky fluid, and the lab confirms it's lymph. Iatrogenic thoracic duct injury. Anatomically, where is the most likely spot?

A. Aortic hiatus at T12

B. Lateral to the left crus of the diaphragm at T12

C. Esophageal hiatus at T10

D. Caval hiatus at T8

Answer with your reasoning, and no shame if you have to dig up the diaphragm mnemonic to do it. Full breakdown tomorrow in the comments. Case from the USMLE Mastery (Step 1 prep) question bank.

I've only ever heard of cases in the retroperitoneal area so this is a first for me😅