MSCT直接淋巴管造影在弥漫性肺淋巴管瘤病中的诊断价值

摘要

目的 探讨MSCT淋巴管造影在弥漫性肺淋巴管瘤病(DPL)中的诊断价值.方法 收集经临床和病理证实的DPL患者18例,由2名医师分别对其淋巴管造影表现及其发生率进行分析.结果 18例DPL患者的胸部表现包括:对比剂反流18例(100％)、淋巴管扩张18例(100％)、纵隔软组织肥厚18例(100％)、中轴支气管血管束增厚18例(100％)、小叶间隔增厚15例(83.33％)、叶间裂增厚15例(83.33％)、双肺磨玻璃影14例(77.78％),以及胸腔积液17例(94.44％)、胸膜增厚9例(50.00％)、胸膜外软组织增厚11例(61.11％)、心包积液和心包增厚16例(88.89％)、纵隔淋巴结肿大8例(44.44％)、胸腔和纵隔心包积气4例(22.22％)、胸廓塌陷3例(16.67％)；胸外异常表现包括:腹膜后对比剂反流和淋巴管扩张4例(22.22％)、腹腔积液1例(5.56％)、腹膜后和脾脏囊性淋巴管瘤各1例(5.56％)、颈部淋巴管扩张8例(44.44％)、胸导管出口梗阻8例(44.44％)、颈部多发淋巴结10例(62.50％)、腋窝多发淋巴结16例(88.89％)、下肢淋巴水肿1例(5.56％)、颜面部水肿1例(5.56％)和骨骼异常3例(16.67％).结论 MSCT直接淋巴管造影能通过显示对比剂的异常分布和堆积明确判断有无淋巴液反流和淋巴管扩张及增多,为诊断和治疗DPL提供重要依据.%Objective To explore the diagnostic value of MSCT direct lymphangiography in the diffuse pulmonary lym-phangiomatosis (DPL). Methods Eighteen patients with DPL confirmed by clinical and pathological results were enrolled. The findings of MSCT direct lymphangiography were analyzed by 2 doctors. Results The thoracic features of patients with DPL included abnormal return and distribution of contrast medium (18/18, 100%) , the dilatation of lymphatic channels (18/18, 100%), mediastinal soft tissue enlargement (18/18, 100%), peribronchovascular thickening (18/18, 100%), in-terlobular septal thickening (15/18, 83. 33%), fissure interlobar thickening (15/18, 83. 33%), diffuse ground glass opacities (14/18, 77.78%), pleural effusion (17/18, 94.44%), pleural thickening (9/18, 50.00%), extra-pleural soft tissue thickening (11/18, 61. 11%), pericardial effusion and thickened pericardium (16/18, 88. 89%), multiple lymphadenopa-thy in mediastinum and axilla (8/18, 44. 44%), pneumo-thorax/mediastinum/pericardium (4/18, 22. 22%) , thoracic collapse (3/18, 16. 67%). The other associated extrathoracic abnormalities included retroperitoneal lymphatic vessels dilation and return of lymphatic fluid (4/18, 22. 22%) , abdominal effusion (1/18, 5. 56%) , retroperitoneal and splenic cystic lym-phangioma (1/18, 5. 56%), cervical lymphatic vessels dilation (8/18, 44. 44%) , thoracic duct outlet obstruction (8/18, 44.44%), multiple small lymphadenopathy in neck (10/18, 62.50%) and axilla (16/18, 88.89%), lower extremity lymphedema (1/18, 5. 56%), facial edema (1/18, 5. 56%) and bone or vertebral lesions (3/18, 16. 67%). Conclusion MSCT direct lymphangiography can clearly show the lymphatic abnormal return and the dilatation and proliferation of lymphatic channels by abnormal distribution of contrast agent, therefore provide important basis for diagnosis and therapy of DPL.