HRCT和CT淋巴管成像在淋巴管平滑肌瘤病中的诊断价值

Diagnostic Value of HRCT and CT Lymphangiography in Lymphangiomyomatosis

目的 探讨HRCT和CT淋巴管成像在淋巴管平滑肌瘤病中的诊断价值。方法 回顾性搜集56例确诊为淋巴管平滑肌瘤病患者的临床和影像资料,所有患者均行胸部HRCT平扫,其中45例于直接淋巴管造影(DLG)后行胸腹盆部CT扫描(CTL),分析胸部病变的HRCT及胸腹盆部CTL影像表现,并采用分类变量资料中的构成比进行统计描述。结果 56例患者的胸部HRCT表现为双肺弥漫大小不等的薄壁含气囊肿56例,肺内磨玻璃密度影16例,肺内结节8例,肺不张32例,支气管血管束增粗12例,小叶间隔增厚25例,心包积液6例,纵隔淋巴结增大9例,胸腔积液45例,气胸12例。45例患者CTL均显示不同部位的碘油异常沉积:胸导管末端24例,右淋巴导管7例,肺内7例,肺门7例,纵隔20例,心包1例,胸腔7例,肋间17例,腋窝6例,横膈周围32例,脊柱旁27例,腹盆腔45例,双髂41例,双侧腹股沟36例,会阴部3例。此外,3例伴有肝脏血管平滑肌脂肪瘤,8例伴有肾脏血管平滑肌脂肪瘤,3例伴有小肠壁弥漫增厚,31例伴有腹盆腔积液。结论 HRCT和CTL能够显示淋巴管平滑肌瘤病的一些特征性表现,同时伴有不同部位的淋巴管异常,为本病的诊断和鉴别提供重要的影像学依据。

Objective To investigate the diagnostic value of HRCT and CT lymphangiography in lymphangiomyomatosis. Methods The clinical and imaging data of 56 patients with lymphangiomyomatosis were collected retrospectively.All patients underwent chest high resolution CT(HRCT) flat scan, and 45 cases underwent CT scan(CTL) of chest, abdomen and pelvis after direct lymphangiography(DLG).HRCT and CTL images of chest, abdomen and pelvis were analyzed, and the constituent ratio of classified variable data was used for statistical description. Results Chest HRCT findings of 56 patients showed diffuse thin walled air cysts of different sizes in both lungs, the lung ground glass density 16 cases, 8 cases within the lung nodules, atelectasis 32 cases, bronchus enlargement of blood vessel bundle 12 cases,interlobular septal thickening 25 cases, pericardial effusion 6 cases, mediastinal lymph node enlargement 9 cases, pleural effusion 45 cases and pneumothorax 12 cases.CTL 45 patients showed abnormal iodine oil from different parts of the deposit: 24 cases of the end of thoracic duct, 7 cases with right lymphatic catheter, 7 cases were intrapulmonary and 7 cases were hilum, mediastinum 20 cases, pericardium 1 case, pleural cavity 7 cases, Intercostal 17 cases, axillary 6 cases, diaphragmatic around 32 cases, 27 cases of spinal column, abdominal pelvic 45 cases, double iliac 41 cases, bilateral inguinal 36 cases and perineum 3 cases.In addition, 3 patients had hepatic angiomyolipoma, 8 patients had renal angiomyolipoma, 3 patients had diffuse intestinal wall thickening, and 31 patients had abdominal and pelvic effusion. Conclusion HRCT and CTL can show some characteristic manifestations of lymphangiomyoma disease, accompanied by lymphangiopathy in different sites, providing an important imaging basis for the diagnosis and identification of the disease.