CT淋巴管成像在原发性乳糜性心包积液中的诊断价值

Primary Chylopericardium: A Study Based on CT Lymphangiography

目的 探讨CT淋巴管造影(CTL)诊断原发性乳糜性心包积液淋巴回流障碍的价值。方法 回顾性分析39例原发性乳糜性心包积液患者的临床及影像学资料,所有患者均行直接淋巴管造影(DLG)后CTL扫描。CTL评价颈部、胸部及腹盆部对比剂异常分布、反流及心包、纵隔、双肺异常表现。采用定性资料的构成比进行统计学描述。结果 39例患者CTL均显示不同部位碘油异常沉积及反流。(1)颈部、腋窝:胸导管末端11例,右淋巴导管末端3例,颈干反流24例,锁骨下干反流25例,腋窝4例;(2)胸部:支气管纵隔干反流23例,前纵隔22例,主肺动脉窗12例,气管、支气管周29例,隆突下30例,后纵隔24例,胸导管主干反流7例,心包反流15例,其中11例经支气管纵隔干反流,肋间、胸膜、横膈上对比剂异常分布10例;(3)腹盆部:横膈下4例,造影侧髂淋巴管扩张、纡曲18例,对侧髂部反流21例,同侧腰干对比剂异常分布16例,对侧腰干反流23例。淋巴管外异常表现:39例均显示心包腔内液性密度影。2例伴纵隔软组织混浊、肿胀。24例存在双肺异常表现,小叶间隔增厚10例,磨玻璃密度影11例,支气管血管束增粗10例,支气管管壁增厚5例,胸腔积液16例,肺不张或膨胀不全11例。16例患者手术治疗,术后7例缓解。结论 CTL可显示原发性乳糜性心包积液胸导管及属支异常,并可显示该疾病的纵隔、心包及双肺异常病变,有助于对本病发病机制的探讨、诊断及鉴别诊断。

Objective To investigate the diagnostic value of CT lymphangiography(CTL) in primary chylopericardium. Methods The clinical and imaging data of 39 patients with primary chylopericardium were retrospectively analyzed. All patients underwent CTL scan. CTL was used to evaluate the abnormal distribution of contrast agents in the neck, chest, abdomen and pelvis, reflux and abnormal manifestations of pericardium, mediastinum and lungs. The composition ratio of qualitative data was used for statistical description. Results All 39 patients with CTL showed abnormal iodine oil deposition and reflux at different sites:(1) neck: 11 cases of the end of thoracic duct, 3 cases of the end of right lymphatic duct, 24 cases of cervical trunk reflux, 25 cases of subclavian trunk reflux;(2) chest: 23 cases of bronchial mediastinal trunk reflux, 22 cases of anterior mediastinum, 12 cases of main pulmonary artery window, 29 cases of peritracheal and bronchial, 30 cases of subcarina, 24 cases of posterior mediastinum, 7 cases of thoracic duct trunk reflux, 15 cases of pericardial reflux, 11 of which were transbronchial mediastinal trunk reflux, and 10 cases of abnormal distribution of intercostal, pleural, and Supra-diaphragm.(3) Abnormalities in the abdomen and pelvic region: 4 cases in the subdiaphragm, 18 cases of dilated and condensed iliac lymphatics on the contrast side, 21 cases of contralateral iliac reflux, 16 cases of abnormal distribution of contrast in the ipsilateral lumbar trunk, and 23 cases of contralateral lumbar trunk reflux. Extra-lymphatic manifestations of abnormalities: 39 cases showed fluid density in the pericardial cavity, 2 cases showed cloudy and swollen mediastinal soft tissues, 24 cases showed abnormalities in both lungs, 10 cases showed thickened lobular septa, 11 cases showed ground glass density, 10 cases showed thickened bronchovascular bundles, 5 cases showed thickened bronchial walls, 16 cases showed pleural effusion, and 11 cases showed pulmonary atelectasis or insufficiency.16 patients were treated surgically and 7 cases were relieved after surgery. Conclusion CT lymphangiography can show the abnormalities of thoracic duct and accessory branches in primary chylopericardium, and abnormal lesions of mediastinum, pericardium and lungs in this disease, which can help to explore the pathogenesis, diagnosis and differential diagnosis of this disease.