感染引起淋巴结肿大致真性乳糜胸1例报告及文献复习

True chylothorax induced by infection-caused lymphadenopathy:A case report and literature review

目的:分析1例乳糜胸患者的临床诊治过程,并结合相关文献复习探讨乳糜胸的病因,以提高临床医生对乳糜胸罕见病因的认识。方法:1例女性患者,以咳嗽、胸痛及呼吸困难为首发症状,查体左侧颈部淋巴结肿大,胸部CT显示为双侧胸腔积液,胸水穿刺引流并送检化验,结果证实为乳糜胸。与乳糜胸产生相关的常见病因检查结果皆为阴性,最终临床诊断为感染性乳糜胸。给予抗感染治疗5d。结果:治疗后患者症状明显好转,复查胸腔彩超显示双侧胸腔积液已完全吸收,浅表肿大淋巴结缩小。1个月后随访症状消失,浅表淋巴结未触及,胸部CT未见异常。结论:对于临床上诊断困难的乳糜胸患者,应考虑到感染的可能,并给予积极抗感染治疗,避免漏诊、误诊和延误病情。

Objective:To explore the etiology of chylothorax by analyzing the clinical data of one patient with chylothorax and combining with the review of relative literatures,and to improve the ability of clinicians for understanding the rare etiology of chylothorax.Methods:A young female with cough,chest pain and dyspnea as the first symptom was admitted to the hospital.Left lymph node enlargement in the neck of the patient was found in examination and bilateral pleural effusion was found in chest CT scanning.After puncture drainage and testing,the pleural effusion was confirmed the chylothorax.Since the examinations for common causes of chylothorax produced negative results,the patient was eventually diagnosed as infectious chylothorax.The patient received anti-infective therapy for 5 d.Results:After treatment,the symptoms of the patients were improved obviously;the pleural effusion disappeared,and the lymph nodes in the neck were shrink detected with chest color ultrasound.One month after follow-up,all the symptoms,enlarged lymph nodes and pleural effusion were recovered.There was no abnormity in chest CT.Conclusion:The possibility of infection should be considered in clinic for the patients with atypical chylothorax and anti-infective treatment should be performed in order to avoid the failed diagnosis and misdiagnosis.