乳糜痰的临床及影像学表现
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摘要
目的探讨乳糜痰的临床及影像学表现。方法搜集6例乳糜痰完整的临床资料、直接淋巴管造影和造影后CT资料,以及1例乳糜痰的支气管镜资料,分析其CT表现及淋巴回流异常。结果 6例乳糜痰患者均有不同程度咳乳白色痰液的病史,病程5个月~27年不等,伴有不同程度的乳糜胸和/或乳糜心包等。乳糜痰在CT上表现为腺泡状、片絮状磨玻璃样渗出,2例伴有肺内间隔的增厚。6例中5例表现为胸导管末端梗阻,3例伴有右淋巴导管走行区对比剂异常分布,3例伴有纵隔对比剂的异常分布,2例伴有肺内对比剂的异常分布。6例均表现为髂、腰淋巴管的迂曲、扩张。1例行支气管镜检查者提示支气管黏膜下淋巴管扩张。结论乳糜痰的临床表现具有一定的特征性,直接淋巴管造影及造影后CT可以为乳糜痰合并淋巴回流异常提供一定的信息。
Objective To explore the clinical and imaging findings of chyloptysis.Methods The complete clinical,direct lymphangiography and post-procedural CT data of 6 cases of chyloptysis were collected.1 case had an additional to bronchoscopy.The CT imaging and abnormal lymphatic reflux was analyzed.Results The 6 patients with chyloptysis had milk white sputum from 5 months to 27 years,accompanied by various degrees of chylothorax and/or chyloperitonium.Chyloptysis showed acinar and/or patchy ground glass exudation,accompanied by interval thickening of the lung in 2 cases.In the 6 cases,5 had thoracic duct end obstruction,accompanied by abnormal distribution of contrast agent in right lymphatic duct in 3 cases,in mediastinum in 3 cases,in lung in 2 cases.All of 6 cases had tortuous and dilated iliac and lumbar lymphatic vessels.One case showed lymphatic vessels dilation of bronchial submucosa under bronchoscopy.Conclusion The chyloptysis has characteristic clinical manifestations.The direct lymphangiography and post-procedural CT can provide a certain amount of information for abnormal lymphatic circumfluence of chyloptysis.
Objective To explore the clinical and imaging findings of chyloptysis.Methods The complete clinical,direct lymphangiography and post-procedural CT data of 6 cases of chyloptysis were collected.1 case had an additional to bronchoscopy.The CT imaging and abnormal lymphatic reflux was analyzed.Results The 6 patients with chyloptysis had milk white sputum from 5 months to 27 years,accompanied by various degrees of chylothorax and/or chyloperitonium.Chyloptysis showed acinar and/or patchy ground glass exudation,accompanied by interval thickening of the lung in 2 cases.In the 6 cases,5 had thoracic duct end obstruction,accompanied by abnormal distribution of contrast agent in right lymphatic duct in 3 cases,in mediastinum in 3 cases,in lung in 2 cases.All of 6 cases had tortuous and dilated iliac and lumbar lymphatic vessels.One case showed lymphatic vessels dilation of bronchial submucosa under bronchoscopy.Conclusion The chyloptysis has characteristic clinical manifestations.The direct lymphangiography and post-procedural CT can provide a certain amount of information for abnormal lymphatic circumfluence of chyloptysis.
引文
1 Sanders JS,Rosenow EC 3rd,Piehler JM,et al.Chyloptysis(chylous sputum)due to thoracic lymphangiectasis with successful surgical correction[J].Arch Intern Med,1988,148:1465-1466.
2 Wetherill SF,Davies AL,Mayock RL.Chyloptysis[J].Am J Med,1990,88:437-438.
3 Robotin MC,Edis BD,Weintraub RG,et al.Heart transplantation for chyloptysis after Fontan operation[J].Ann Thorac Surg,1995,59:1570-1571.
4 Orliaguet O,Beauclair P,Gavazzi G,,et al.Thoracic lymphangiectasis presenting with chyloptysis and bronchial cast expectoration[J].Eur Radiol,2002,12:S162-S165.
5 Stoddart A,Dincer HE,Iber C,et al.Chyloptysis causing plastic bronchitis[J].Respir Med Case Rep,2014,8:4-6.
6 Nair LG,Kurtz CP.Lymphangiomatosis presenting with bronchial cast for-mation[J].Thorax,1996,51:765-766.
7 Mavroudi M,Zarogoulidis P,Katsikogiannis N,et al.Lymphangioleiomyomatosis:current and future[J].J Thorac Dis,2013,5:74-79.
8 Lim KG,Rosenow EC 3rd,Staats B,et al.Chyloptysis in adults:presentation,recognition,and differential diagnosis[J].Chest,2004,125:336-340.
9 Weidner WA,Steiner RM.Roentgenographic demonstration of intrapulmonary and pleural lymphatics during lymphangiography[J].Radiology,1971,100:533-539.
10 张春燕,陈孝柏,温廷国,等.原发性乳糜性心包积液淋巴回流障碍的直接淋巴管造影和MSCT表现[J].中国医学影像技术,2013,29:1642-1645.
2 Wetherill SF,Davies AL,Mayock RL.Chyloptysis[J].Am J Med,1990,88:437-438.
3 Robotin MC,Edis BD,Weintraub RG,et al.Heart transplantation for chyloptysis after Fontan operation[J].Ann Thorac Surg,1995,59:1570-1571.
4 Orliaguet O,Beauclair P,Gavazzi G,,et al.Thoracic lymphangiectasis presenting with chyloptysis and bronchial cast expectoration[J].Eur Radiol,2002,12:S162-S165.
5 Stoddart A,Dincer HE,Iber C,et al.Chyloptysis causing plastic bronchitis[J].Respir Med Case Rep,2014,8:4-6.
6 Nair LG,Kurtz CP.Lymphangiomatosis presenting with bronchial cast for-mation[J].Thorax,1996,51:765-766.
7 Mavroudi M,Zarogoulidis P,Katsikogiannis N,et al.Lymphangioleiomyomatosis:current and future[J].J Thorac Dis,2013,5:74-79.
8 Lim KG,Rosenow EC 3rd,Staats B,et al.Chyloptysis in adults:presentation,recognition,and differential diagnosis[J].Chest,2004,125:336-340.
9 Weidner WA,Steiner RM.Roentgenographic demonstration of intrapulmonary and pleural lymphatics during lymphangiography[J].Radiology,1971,100:533-539.
10 张春燕,陈孝柏,温廷国,等.原发性乳糜性心包积液淋巴回流障碍的直接淋巴管造影和MSCT表现[J].中国医学影像技术,2013,29:1642-1645.