MSCT淋巴管成像诊断原发性小肠淋巴管扩张症
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摘要
目的探讨MSCT淋巴管成像在原发性小肠淋巴管扩张症(PIL)中的诊断价值。方法回顾性分析经手术病理证实的16例PIL患者的影像学资料,所有患者均于直接淋巴管造影术后行胸腹部MSCT联合扫描,并行内镜检查,将MSCT图像和手术病理及内镜结果进行对照。结果 16例患者MSCT淋巴管成像均能清晰显示病变肠管及肠管以外病变,肠管扩张14例,肠壁增厚13例,胸腔积液5例,腹腔积液7例,心包积液3例,肠系膜水肿12例,肠系膜结节6例,腹腔淋巴管瘤2例;肠淋巴干反流7例,腰淋巴干反流13例,胸膜及肺内淋巴反流3例,心包纵隔淋巴反流3例,纵隔肺淋巴反流4例,T8以下水平胸导管梗阻1例,胸导管出口梗阻14例。结论 MSCT淋巴管成像可以清晰显示PIL肠管本身及肠管以外病变的部位、范围及程度,为临床诊断和治疗提供重要依据。
Objective To explore the application of MSCT lymphangiography in diagnosing primary intestinal lymphangiectasis( PIL).Methods Imaging materials of 16 patients with pathologically confirmed PIL confirmed were retrospectively analyzed.Direct lymphangiography was carried out in all patients,which was followed by thoracic and abdominal MSCT scanning and endoscopy examination.MSCT manifestations were compared with operational,pathological and endoscopic findings.Results In all patients MSCT lymphangiography could clearly display the intestinal and extra-intestinal lesions,which included dilatation of intestinal canal( n = 14),bowel wall thickening( n = 13),pleural effusion( n = 5),ascites( n = 7),pericardial effusion( n = 3),mesenteric edema( n = 12),mesenteric nodules( n = 6),abdominal lymphangioma( n = 2),intestinal lymph trunk reflux( n = 7),lumbar lymph trunk reflux( n = 13),pleural and pulmonary lymph reflux( n = 3),pericardial and mediastinal lymph reflux( n = 3),mediastinal and pulmonary lymph reflux( n = 4),obstruction of thoracic duct at T8 level( n = 1) and exit obstruction of thoracic duct( n = 14).Conclusion MSCT lymphangiography can clearly display the location,extent and degree of intestinal and extra-intestinal lesions of PIL,providing the basic evidence for the diagnosis and treatment of PIL.
Objective To explore the application of MSCT lymphangiography in diagnosing primary intestinal lymphangiectasis( PIL).Methods Imaging materials of 16 patients with pathologically confirmed PIL confirmed were retrospectively analyzed.Direct lymphangiography was carried out in all patients,which was followed by thoracic and abdominal MSCT scanning and endoscopy examination.MSCT manifestations were compared with operational,pathological and endoscopic findings.Results In all patients MSCT lymphangiography could clearly display the intestinal and extra-intestinal lesions,which included dilatation of intestinal canal( n = 14),bowel wall thickening( n = 13),pleural effusion( n = 5),ascites( n = 7),pericardial effusion( n = 3),mesenteric edema( n = 12),mesenteric nodules( n = 6),abdominal lymphangioma( n = 2),intestinal lymph trunk reflux( n = 7),lumbar lymph trunk reflux( n = 13),pleural and pulmonary lymph reflux( n = 3),pericardial and mediastinal lymph reflux( n = 3),mediastinal and pulmonary lymph reflux( n = 4),obstruction of thoracic duct at T8 level( n = 1) and exit obstruction of thoracic duct( n = 14).Conclusion MSCT lymphangiography can clearly display the location,extent and degree of intestinal and extra-intestinal lesions of PIL,providing the basic evidence for the diagnosis and treatment of PIL.
引文
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2 宋建美,陈孝柏,赵君,等.直接淋巴管造影后CT及增强CT对小肠淋巴管扩张症的诊断价值[J].中国医学影像技术,2012,28:197-200.
3 张建梅,陈孝柏,赵桐,等.小肠淋巴管扩张症在直接淋巴管造影及造影后CT平扫中的影像表现[J].临床放射学杂志,2012,31:65-69.
4 桂巧巧,甘华,陶小红.原发性小肠淋巴管扩张症[J].中华消化杂志,2011,31:420-421.
5 Wen J,Tang Q,Wu J,et al.Primary intestinal lymphangiectasia:four case reports and a review of the literature[J].Dig Dis Sci,2010,55:3466-3472.
6 Mazzie JP,Maslin PI,Moy L,et al.Congenital intestinal lymphangiectasia:CT demonstration in a young child[J].Clin Imaging,2003,27:330-332.
7 Sahli H,Ben Mbarek R,Elleuch M,et al.Osteomalacia in a patient with primary intestinal lymphangiectasis(Waldmann's disease)[J].Joint Bone Spine,2008,75:73-75.
8 Vignes S,Bellanger J.Primary intestinal lymphangiectasia(Waldmann's disease)[J].Orphanet J Rare Dis,2008,22:3-5.
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11 Kalman S,Bakkaloglu S,Dalgic B,et al.Recurrent hemolytic uremic syndrome associated with intestinal lymphangiectasia[J].J Nephrol,2007,20:246-249.
12 Schmider A,Henrich W,Reles A,et al.Isolated fetal ascites caused by primary lymphangiectasia:a case report[J].Am J Obstet Gynecol,2001,184:227-228.
13 Furukawa A,Kanasaki S,Kono N,et al.CT diagnosis of acute mesenteric ischemia from various causes[J].AJR,2009,192:408-416.
14 Okkes I.Karahan OI,Dodd GD,et al.Gastrointestinal Wall Thickening in Patients with Cirrhosis:Frequency and Patterns at Contrast enhanced CT[J].Radiology,2000,215:103-107.
15 Gore RM,Balthazar EJ,Ghahremani GG,et al.CT features of ulcerative colitis and Crohn's disease[J].AJR,1996,167:3-15.
16 Keberle M,Mork H,Jenett M,et al.Computed tomography after lymphangiography in the diagnosis of intestinal lymphangiectasia with protein-losing enteropathy in Noonan's syndrome[J].Eur Radiol,2000,10:1591-1593.
17 陈孝柏,魏海亮,张建梅,等.直接淋巴管造影对胸导管出口梗阻的诊断价值[J].中华放射学杂志,2013,47:401-404.
18 张春燕,王仁贵,沈丽辉,等.综合影像学诊断下肢乳糜反流性淋巴水肿[J].中国医学影像技术,2013,29:437-440.
2 宋建美,陈孝柏,赵君,等.直接淋巴管造影后CT及增强CT对小肠淋巴管扩张症的诊断价值[J].中国医学影像技术,2012,28:197-200.
3 张建梅,陈孝柏,赵桐,等.小肠淋巴管扩张症在直接淋巴管造影及造影后CT平扫中的影像表现[J].临床放射学杂志,2012,31:65-69.
4 桂巧巧,甘华,陶小红.原发性小肠淋巴管扩张症[J].中华消化杂志,2011,31:420-421.
5 Wen J,Tang Q,Wu J,et al.Primary intestinal lymphangiectasia:four case reports and a review of the literature[J].Dig Dis Sci,2010,55:3466-3472.
6 Mazzie JP,Maslin PI,Moy L,et al.Congenital intestinal lymphangiectasia:CT demonstration in a young child[J].Clin Imaging,2003,27:330-332.
7 Sahli H,Ben Mbarek R,Elleuch M,et al.Osteomalacia in a patient with primary intestinal lymphangiectasis(Waldmann's disease)[J].Joint Bone Spine,2008,75:73-75.
8 Vignes S,Bellanger J.Primary intestinal lymphangiectasia(Waldmann's disease)[J].Orphanet J Rare Dis,2008,22:3-5.
9 Freeman HJ,Nimmo M.Intestinal lymphangiectasia in adults[J].World J Gastrointest Oncol,2011,3:19-23.
10 Cammarota G,Cianci R,Gasbarrini G.High-resolution magnifying video endoscopy in primary intestinal lymphangiectasia:a new role for endoscopy?[J].Endoscopy,2005,37:607.
11 Kalman S,Bakkaloglu S,Dalgic B,et al.Recurrent hemolytic uremic syndrome associated with intestinal lymphangiectasia[J].J Nephrol,2007,20:246-249.
12 Schmider A,Henrich W,Reles A,et al.Isolated fetal ascites caused by primary lymphangiectasia:a case report[J].Am J Obstet Gynecol,2001,184:227-228.
13 Furukawa A,Kanasaki S,Kono N,et al.CT diagnosis of acute mesenteric ischemia from various causes[J].AJR,2009,192:408-416.
14 Okkes I.Karahan OI,Dodd GD,et al.Gastrointestinal Wall Thickening in Patients with Cirrhosis:Frequency and Patterns at Contrast enhanced CT[J].Radiology,2000,215:103-107.
15 Gore RM,Balthazar EJ,Ghahremani GG,et al.CT features of ulcerative colitis and Crohn's disease[J].AJR,1996,167:3-15.
16 Keberle M,Mork H,Jenett M,et al.Computed tomography after lymphangiography in the diagnosis of intestinal lymphangiectasia with protein-losing enteropathy in Noonan's syndrome[J].Eur Radiol,2000,10:1591-1593.
17 陈孝柏,魏海亮,张建梅,等.直接淋巴管造影对胸导管出口梗阻的诊断价值[J].中华放射学杂志,2013,47:401-404.
18 张春燕,王仁贵,沈丽辉,等.综合影像学诊断下肢乳糜反流性淋巴水肿[J].中国医学影像技术,2013,29:437-440.