CT淋巴管造影对淋巴管肌瘤病乳糜胸的诊断价值
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摘要
目的:探讨CT淋巴管造影对淋巴管肌瘤病乳糜胸的诊断价值。方法:回顾性分析2009至2014年我院38例临床或病理证实的LAM患者及172例非LAM乳糜胸患者的临床及影像学资料,所有患者均接受淋巴管造影(DLG)及淋巴管造影后CT检查,由2名医师对CT淋巴管造影(CTL)显示乳糜胸的发生部位、分布类型及胸导管梗阻情况进行分析。结果:CTL显示36例LAM合并乳糜胸。单侧积液23例(右侧11例,左侧12例),双侧积液13例;脏层胸膜型3例,壁层胸膜型7例,混合型4例,未显示型22例。172例非LAM乳糜胸(原发性乳糜胸118例,继发性乳糜胸54例)。118例原发性乳糜胸中,右侧积液26例,左侧积液27例,双侧积液65例;脏层型60例,壁层型15例,混合型23例,未显示型20例。54例继发性乳糜胸中,右侧积液13例,左侧积液3例,双侧积液38例;脏层型43例,壁层型2例,混合型6例,未显示型3例。LAM乳糜胸与原发性乳糜胸的发生部位不存在差异,LAM乳糜胸与继发性乳糜胸的发生部位存在差异。LAM乳糜胸的发生侧别几乎没有差别,继发性乳糜胸常见为双侧。LAM乳糜胸与原发性乳糜胸和继发性乳糜胸在胸膜类型上存在差异,LAM乳糜胸以未显示型最常见,而原发性和继发性乳糜胸以脏层型最常见。结论:CTL可显示LAM乳糜胸的发生类型,提示胸导管梗阻或者腹腔淋巴管压力增高可能是LAM乳糜胸的致病原因,为临床手术治疗LAM乳糜胸提供影像学依据。
Objective: To explore the diagnosis value of CT lymphangiography(CTL) about chylothorax of lymphangioleiomyomatosis(LAM). Methods: A retrospective review of the clinical and radiological data of 38 LAM and 172 non-LAM-chylothorax patients. The distribution and pattern of chylothorax and in CTL were analyzed by 2 doctors. Results: 36 LAM accompanied with chylothorax. There is no difference between LAM and primary chylothorax about the distribution of chylothorax. There is difference between LAM and secondary chylothorax about the distribution of chylothorax. Secondary chylothorax is usually bilateral. The common pleura pattern of LAM chylothorax is no-manifestation, whereas visceral pleura pattern is common in primary and secondary chylothorax. Conclusions: CTL can display the pattern of chylothorax for LAM, which suggests that abnormality of thoracic duct extremity or high pressure of abdominal lymphatic vessel maybe the etiopathogenisis of chylothorax for LAM, which provides information to therapy chylothorax of LAM.
Objective: To explore the diagnosis value of CT lymphangiography(CTL) about chylothorax of lymphangioleiomyomatosis(LAM). Methods: A retrospective review of the clinical and radiological data of 38 LAM and 172 non-LAM-chylothorax patients. The distribution and pattern of chylothorax and in CTL were analyzed by 2 doctors. Results: 36 LAM accompanied with chylothorax. There is no difference between LAM and primary chylothorax about the distribution of chylothorax. There is difference between LAM and secondary chylothorax about the distribution of chylothorax. Secondary chylothorax is usually bilateral. The common pleura pattern of LAM chylothorax is no-manifestation, whereas visceral pleura pattern is common in primary and secondary chylothorax. Conclusions: CTL can display the pattern of chylothorax for LAM, which suggests that abnormality of thoracic duct extremity or high pressure of abdominal lymphatic vessel maybe the etiopathogenisis of chylothorax for LAM, which provides information to therapy chylothorax of LAM.
引文
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[2]Doerr CH,Allen MS,Nicholas FC,et al.Etiology of chylothorax in 203 patients[J].Mayo Clinic Proceedings,2005,80:867-870.
[3]Taylor JR,Ryu J,Colby TV,et al.Lymphangioleiomyomatosis:Clinical course in 32patients[J].The New England Journal of Medicine,1990,323:1254-1260.
[4]张奇瑾,张春燕,陈孝柏.CT淋巴管造影对淋巴管肌瘤病淋巴回流障碍的诊断价值[J].中华放射学杂志,2013,47(9):801-804.Zhang QJ,Zhang CY,Chen XB.Diagnostic value of CT lymphangiography about lymphatic flow disorder of lymphangioleiomyomatosis[J].Chinese Journal of Radiology,2013,47(9):801-804.(in Chinese).
[5]Ryu JH,Doerr CH,Fisher SD,et al.Chylothorax in lymphangioleiomyomatosis[J].Chest,2003,123(2):623-627.
[6]Johnson SR,Cordier JF,Lazor R,et al.European Respiratory Society guidelines for the diagnosis and management of lymphangioleiomyomatosis[J].European Respiratory Journal,2010,35:14-26.
[7]Guermazi A,Brice P,Hennequin C,et al.Lymphography:An old technique retains its usefulness[J].Radiographics,2003,23(6):1541-60.
[8]Tutor JD.Chylothorax in infants and children[J].Pediatrics,2014,133:722-733.
[9]张涤生.实用淋巴医学[M].北京:人民军医出版社,2007.
[10]Maldonado F,Hawkins FJ,Daniels CE,et al.Pleural fluid characteristics of chylothorax[J].Mayo Clinic Proceedings,2009,84:129,133.
[11]Agostoni E,Zocchi L.Pleural liquid and its exchanges[J].Respiratory Physilolgy and Neurobiology,2007,159:311-323.
[12]Risius B,Lammert GK.Diagnosis and localization of laceration of the thoracic duct:Usefulness of lymphangiography and CT[J].American Journal of Roentgenology,1991,157:703-705.
[13]Maldonado F,Cartin-ceba R,Hawkins FJ,et al.Medical and surgical management of chylothorax and associated outcomes[J].The American Journal of the Medical Sciences,2010,339:314-318.