淋巴管肌瘤病合并乳糜性胸、腹腔积液的影像学表现与手术对照
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摘要
目的探讨淋巴管肌瘤病(LAM)合并乳糜性胸、腹腔积液的影像学表现。方法回顾性分析20例合并乳糜性胸、腹腔积液的LAM患者的直接淋巴管造影(DLG)及CT资料,其中15例行胸导管探查,18例行手术治疗。结果 20例LAM均合并不同程度的乳糜性胸腔积液,其中8例合并乳糜性腹腔积液。DLG显示20例LAM腹膜后及髂淋巴管均不同程度扩张,并5例向对侧返流。DLG直观显示14例胸导管出口受阻,其中13例行胸导管探查证实梗阻存在,并行胸导管梗阻解除术,1例胸、腹腔积液完全消失,12例减少或趋于稳定。6例胸导管部分于DLG未见明确显示,其中2例为胸导管结扎术后,1例行髂外淋巴管静脉吻合术后腹腔积液好转;其余4例中2例行胸导管探查证实出口受阻,行胸导管出口梗阻解除术后胸、腹腔积液减少;另2例未行胸导管探查,行髂外或下肢淋巴管静脉吻合术后腹腔积液减少。结论 DLG及CT成像可为LAM合并乳糜性胸、腹腔积液的诊断及治疗提供重要信息。
Objective To explore the imaging findings of lymphangioleiomyomatosis(LAM) accompanied with celiac hydrothorax and ascites.Methods The direct lymphangiography(DLG) and CT imaging findings of 20 patients with LAM accompanied by celiac hydrothorax and ascites were retrospectively analyzed,in which 15 LAM underwent thoracic duct exploration and 18 underwent operation.Results CT showed 20 LAM combining with celiac pleural effusion,accompanied by 8 with ascites.DLG showed all of the 20 LAM iliac and /or retroperitoneal lymphatic vessels were dilated.5 cases refluxed to contralateral iliac and /or retroperitoneal lymphatic.14 thoracic duct occluded were intuitively seen by DLG,in which obstructions were confirmed by thoracic duct exploration and received relieving obstruction operation in 13 cases,hydrothorax and ascites were disappeared in 1 case,and decreased or stabilized in 12 cases.6 thoracic ducts from lumbar vertebra 5 to thoracic vertebra 8 were not seen by DLG,and 2 thoracic duct obstruction were confirmed by thoracic duct exploration,in which 1 was operated by external iliac lymphatic vein anastomosis and ascites improved.2 of the other 4 LAM were confirmed with thoracic duct occlusion by thoracic duct exploration,the hydrothorax and ascites were diminuted with obstruction removing,the other 2 cases did not received horacic duct exploration and performed with external iliac or lower limb lymphatic vein anastomosis and ascites improved.Conclusion DLG and CT can provide important information for diagnosis and therapy of LAM accompanied by celiac hydrothorax and ascites.
Objective To explore the imaging findings of lymphangioleiomyomatosis(LAM) accompanied with celiac hydrothorax and ascites.Methods The direct lymphangiography(DLG) and CT imaging findings of 20 patients with LAM accompanied by celiac hydrothorax and ascites were retrospectively analyzed,in which 15 LAM underwent thoracic duct exploration and 18 underwent operation.Results CT showed 20 LAM combining with celiac pleural effusion,accompanied by 8 with ascites.DLG showed all of the 20 LAM iliac and /or retroperitoneal lymphatic vessels were dilated.5 cases refluxed to contralateral iliac and /or retroperitoneal lymphatic.14 thoracic duct occluded were intuitively seen by DLG,in which obstructions were confirmed by thoracic duct exploration and received relieving obstruction operation in 13 cases,hydrothorax and ascites were disappeared in 1 case,and decreased or stabilized in 12 cases.6 thoracic ducts from lumbar vertebra 5 to thoracic vertebra 8 were not seen by DLG,and 2 thoracic duct obstruction were confirmed by thoracic duct exploration,in which 1 was operated by external iliac lymphatic vein anastomosis and ascites improved.2 of the other 4 LAM were confirmed with thoracic duct occlusion by thoracic duct exploration,the hydrothorax and ascites were diminuted with obstruction removing,the other 2 cases did not received horacic duct exploration and performed with external iliac or lower limb lymphatic vein anastomosis and ascites improved.Conclusion DLG and CT can provide important information for diagnosis and therapy of LAM accompanied by celiac hydrothorax and ascites.
引文
1 Raman SP,Pipavath SN,Raghu G,et al.Imaging of thoracic lym-phatic diseases.AJR,2009,193:1504
2 Torres VE,Bjornsson J,King BF,et al.Extrapulmonary lymphangio-leiomyomatosis and lymphangiomatous cysts in tuberous sclerosiscomplex.Mayo Clin Proc,1995,70:641
3朱先进,王武.淋巴管平滑肌瘤病的临床、病理及影像学表现.临床放射学杂志,2008,27:851
4张春燕,陈孝柏,侯睿,等.直接淋巴管造影后MSCT诊断乳糜胸.中国医学影像技术,2012,28:197
5刘颖,曹代荣,李银官,等.多脏器淋巴管肌瘤病的MSCT表现.中国医学影像技术,2009,25:125
6周璐,张竹花,金征宇.肺淋巴管肌瘤病的临床表现及HRCT特点.临床放射学杂志,2007,26:997
7 Ferrans VJ,Yu ZX,Nelson WK,et al.Lymphangioleiomyomatosis(LAM):a review of clinical and morphological features.J NipponMed Sch,2000,67:311
8 Avila NA,Dwyer AJ,Rabel A,et al.Sporadic lymphangioleiomyoma-tosis and tuberous sclerosis complex with lymphangioleiomyomatosis:comparison of CT features.Radiology,2007,242:277
9 Lim KE,Tsai YH,Hsu YIY,et al.Pulmonary lymphangioleiomyoma-tosis.High-resolution CT findings in 11 patients and compared withthe literature.Clin Imaging,2004,28:1
10 Avila NA,Kelly JA,Chu SC,et al.Lymphangioleiomyomatosis:ab-dominopelvic CT and US findings.Radiology,2000,216:147
11 Ryu JH,Doerr CH,Fisher SD,et al.Chylothorax in lymphangioleio-myomatosis.Chest,2003,123:623
12 Morbini P,Guddo F,Contini P,et al.Rare diffuse diseases of lung.Pulmonary alveolar proteinosis,lymphangioleiomyomatosis,amyloid-osis.Pathologica,2010,102:547
13 Pallisa E,Sanz P,Roman A,et al.Lymphangioleiomyomatosis:pul-monary and abdominal findings with pathologic correlation.Radio-Graphics,2002,22:185
14 Sachs PB,Zelch MG,Rice TW,et al.Diagnosis and localization oflaceration of the thoracic duct:usefulness of lymphangiography andCT.AJR,1991,157:703
2 Torres VE,Bjornsson J,King BF,et al.Extrapulmonary lymphangio-leiomyomatosis and lymphangiomatous cysts in tuberous sclerosiscomplex.Mayo Clin Proc,1995,70:641
3朱先进,王武.淋巴管平滑肌瘤病的临床、病理及影像学表现.临床放射学杂志,2008,27:851
4张春燕,陈孝柏,侯睿,等.直接淋巴管造影后MSCT诊断乳糜胸.中国医学影像技术,2012,28:197
5刘颖,曹代荣,李银官,等.多脏器淋巴管肌瘤病的MSCT表现.中国医学影像技术,2009,25:125
6周璐,张竹花,金征宇.肺淋巴管肌瘤病的临床表现及HRCT特点.临床放射学杂志,2007,26:997
7 Ferrans VJ,Yu ZX,Nelson WK,et al.Lymphangioleiomyomatosis(LAM):a review of clinical and morphological features.J NipponMed Sch,2000,67:311
8 Avila NA,Dwyer AJ,Rabel A,et al.Sporadic lymphangioleiomyoma-tosis and tuberous sclerosis complex with lymphangioleiomyomatosis:comparison of CT features.Radiology,2007,242:277
9 Lim KE,Tsai YH,Hsu YIY,et al.Pulmonary lymphangioleiomyoma-tosis.High-resolution CT findings in 11 patients and compared withthe literature.Clin Imaging,2004,28:1
10 Avila NA,Kelly JA,Chu SC,et al.Lymphangioleiomyomatosis:ab-dominopelvic CT and US findings.Radiology,2000,216:147
11 Ryu JH,Doerr CH,Fisher SD,et al.Chylothorax in lymphangioleio-myomatosis.Chest,2003,123:623
12 Morbini P,Guddo F,Contini P,et al.Rare diffuse diseases of lung.Pulmonary alveolar proteinosis,lymphangioleiomyomatosis,amyloid-osis.Pathologica,2010,102:547
13 Pallisa E,Sanz P,Roman A,et al.Lymphangioleiomyomatosis:pul-monary and abdominal findings with pathologic correlation.Radio-Graphics,2002,22:185
14 Sachs PB,Zelch MG,Rice TW,et al.Diagnosis and localization oflaceration of the thoracic duct:usefulness of lymphangiography andCT.AJR,1991,157:703