Value of imaging examinations in treatment of lymphangioleiomyomatosis with chylothorax by thoracic duct extremity exploration
10.13929/j.1003-3289.201702097
- VernacularTitle:影像学检查在胸导管末端探查术治疗淋巴管肌瘤病合并乳糜胸术式选择中的价值
- Author:
Qijin ZHANG
1
;
Wenbin SHEN
;
Guansheng TONG
;
Chunyan ZHANG
;
Xiaobai CHEN
;
Tingguo WEN
;
Jian DONG
;
Meng HUO
;
Rengui WANG
Author Information
1. 首都医科大学附属北京世纪坛医院放射中心
- Keywords:
Lymphangioleiomyomatosis;
Chylothorax;
Thoracic duct;
Radionuclide lymphoscintigraphy;
Lymphangiography
- From:
Chinese Journal of Medical Imaging Technology
2017;33(10):1517-1521
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the value of imaging examinations in the treatment of lymphangioleiomyomatosis (LAM) with chylothorax by thoracic duct extremity exploration.Methods Data of 34 LAM with chylothorax confirmed by pathology and clinical diagnosis were retrospectively analyzed.All patients underwent 99Tcm-DX lymphoscintigraphy and CT lymphangiography (CTL).Thoracic duct lesion types of 99Tcm-DX lymphoscintigraphy were type Ⅰ (abnormal concentration pattern),type Ⅱ (ectopic drainage pattern),and type Ⅲ (without image or transient image pattern).The type Ⅰ and type Ⅱ were diagnosed as thoracic duct abnormalities.Thoracic duct lesion types of CTL were type Ⅰ (dilatation pattern),type Ⅱ (distal obstruction pattern),type l (truck constriction pattern),type Ⅳ (ectopic drainage pattern),and type Ⅴ (no-display pattern).Type Ⅰ-Ⅳ were diagnosed as thoracic duct abnormalities.Consistency of displaying thoracic duct abnormalities between 99Tcm-DX lymphoscintigraphy and CTL was evaluated.Results The thoracic duct abnormalities in 99Tcm-DX lymphoscintigraphy were 58.82％ (20/34;type Ⅰ in 17,type Ⅱ in 3,type Ⅲ in 14),and in CTL were 73.53％ (25/34;type Ⅰ in 15,type Ⅱ in 3,type Ⅲ in 5,type Ⅳ in 2,type Ⅴ in 9).The consistency of CTL and 99Tcm-DX lymphoscintigraphy for detecting thoracic duct abnormalities was good (Kappa=0.679).In CTL thoracic duct types,type Ⅰ and Ⅱ were operated by thoracic duct-venous anastomosis or thoracic duct extremity release operation,type Ⅲ was operated by thoracic duct adhesion or compression band release operation,operative approach and method were chosen according to the abnormal thoracic duct flow path in type Ⅳ,type Ⅴ was took conservative treatment.Conclusion CTL is superior to 99Tcm-DX lymphoscintigraphy,which can clearly display the type of thoracic duct lesion and provide imaging informations to choose operation methods in thoracic duct exploration treatment for LAM with chylothorax.
