CT淋巴管成像诊断原发性肺淋巴水肿的价值探讨

目的:探讨CT淋巴管成像在原发性肺淋巴水肿中的诊断价值。方法:回顾性收集经临床、影像及病理综合诊断为原发性肺淋巴水肿的患者52例，所有患者均行CT淋巴管成像检查。由两名影像科医师分别对其CT淋巴管成像的表现进行双盲阅片，观察胸部淋巴管异常表现及其他胸部病变的CT征象。结果:CT淋巴管成像表现:碘化油异常沉积的部位为胸导管末端38例（73.1%），纵隔34例（65.4%），肺门22例（42.3%），胸膜18例（34.6%），心包15例（28.8%），横膈5例（9.6%），肝门处9例（17.3%），胰腺5例（9.6%），腹膜后12例（23.1%）。常规胸部CT表现:①肺内腺泡样磨玻璃 19例（36.5%），肺内斑片状磨玻璃密度23例（44.2%），肺不张11例（21.2%），肺结节3例（5.8%）；②中轴支气管血管束增粗和小叶间隔增厚各 43例（82.7%），小叶内间质增厚4例（7.7%），肺内“蛙卵征”7例（13.5%）；③纵隔异常改变 34例（65.4%）；④其他胸部异常包括肺内“铺路石征”2例（3.8%），胸腔积液和心包积液各18例（34.6%）。结论:CT淋巴管成像可以通过显示对比剂异常沉积和分布间接推测淋巴管异常和有无淋巴反流，从而为诊断和治疗原发性肺淋巴水肿提供有价值的影像学依据。 

Application of CT Lymphangiography in the Diagnosiis of Primary Pulmonary Lymphedema

Objective: To explore the clinical value of CT lymphangiography in diagnosing primary pulmonary lymphedema. Methods: 52 patients who were diagnosed by clinical, imaging and pathology as primary pulmonary lymphedema were analyzed retrospectively. All patients underwent CT lymphangiography. Two experienced radiologists carried out double-blind film reading of the CT lymphangiography manifestations, and observed the abnormal perfomance of lymphatic vessels in the chest as well as CT signs of other chest diseases.Results: CT lymphangiography showed contrast agent abnormity deposited in all 52 patients: the end of thoracic duct was found in 38 cases (73.1%), mediastinum in 34 cases (65.4%), hilar in 22 cases (42.3%), pleura in 18 cases (34.6%), pericardium in 15 cases (28.8%), diaphragm in 5 cases (9.6%), hepatic hilum in 9 cases (17.3%), pancreas in 5 cases (9.6%), retroperitoneum in 12 cases (23.1%). Abnormal CT changes including: (1) alveolar nodule-like ground glass opacity in 19 cases (36.5%), patchy ground glass opacity in 23 cases (44.2%), atelectasis in 11 cases (21.2%), pulmonary nodules in 3 cases (5.8%). (2) the thickening of bronchovascular bundle in 43 cases (82.7%), the thickening of interlobular septum in 43 cases (82.7%), the thickening of intralobular interstitium in 4 cases (7.7%), frog-spawn sign in 7 cases (13.5%). (3) abnormal mediastinum changes in 34 cases (65.4%). (4) other chest CT abnormalities including: the crazy-paving sign in 2 cases (3.8%), pleural effusion in 18 cases (34.6%), pericardial effusion in 18 case (34.6%). Conclusion: CT lymphangiography can indirectly predict the abnormality of lymphatics and the presence or absence of lymphatic reflux by showing the abnormal deposition and distribution of contrast agents, and thus can provide valuable imaging basis for the diagnosis and treatment of primary pulmonary lymphedema.