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目的探讨淋巴管肌瘤病(LAM)合并乳糜性胸、腹腔积液的影像学表现。方法回顾性分析20例合并乳糜性胸、腹腔积液的LAM患者的直接淋巴管造影(DLG)及CT资料,其中15例行胸导管探查,18例行手术治疗。结果 20例LAM均合并不同程度的乳糜性胸腔积液,其中8例合并乳糜性腹腔积液。DLG显示20例LAM腹膜后及髂淋巴管均不同程度扩张,并5例向对侧返流。DLG直观显示14例胸导管出口受阻,其中13例行胸导管探查证实梗阻存在,并行胸导管梗阻解除术,1例胸、腹腔积液完全消失,12例减少或趋于稳定。6例胸导管部分于DLG未见明确显示,其中2例为胸导管结扎术后,1例行髂外淋巴管静脉吻合术后腹腔积液好转;其余4例中2例行胸导管探查证实出口受阻,行胸导管出口梗阻解除术后胸、腹腔积液减少;另2例未行胸导管探查,行髂外或下肢淋巴管静脉吻合术后腹腔积液减少。结论 DLG及CT成像可为LAM合并乳糜性胸、腹腔积液的诊断及治疗提供重要信息。
Objective To investigate the imaging findings of lymphangiomyosarcoma (LAM) combined with chylothorax and ascites. Methods We retrospectively analyzed the direct lymphangiography (DLG) and CT data of 20 cases of LAM patients with chylothorax and pleural effusion. Among them, thoracic catheterization was performed in 15 cases and surgical treatment in 18 cases. Results All 20 cases of LAM combined with different degrees of chylous pleural effusion, including 8 cases with chylous effusion. DLG showed that 20 cases of LAM were retroperitoneal and iliac lymphatic vessels were expanded to varying degrees, and 5 cases of contralateral reflux. DLG visualization of 14 cases of thoracic duct exit blocked, of which thirteen cases of thoracic duct exploration confirmed the existence of obstruction, concurrent thoracic duct obstruction lift, 1 case of pleural and peritoneal effusion completely disappeared, 12 cases reduced or stabilized. 6 cases of thoracic duct in the DLG did not clearly show that 2 cases of thoracic duct ligation, 1 case of external iliac lymphatic veno-venous anastomosis after peritoneal effusion improved; the remaining 4 cases of 2 cases of thoracic duct exploration confirmed that the exit Obstruction, thoracic and ductal outlet obstruction relieved thoracic and peritoneal effusion decreased; the other two cases did not line thoracic catheter exploration, external iliac or lower extremity lymphatic venous anastomosis decreased peritoneal effusion. Conclusion DLG and CT imaging can provide important information for the diagnosis and treatment of LAM combined with chylothorax and ascites.