Lim Kaiser G, Rosenow Edward C, Staats Bruce, Couture Christian, Morgenthaler Timothy I
Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine,Mayo Clinic Foundation, Rocheseter, MN 55905, USA.
Chest. 2004 Jan;125(1):336-40. doi: 10.1378/chest.125.1.336.
Chyloptysis is a rare finding, and the accompanying respiratory symptoms are usually nonspecific. The recognition of the chylous nature of the sputum is requisite for proper diagnosis, especially if chyloptysis is not accompanied by chylous pleural effusion. The key to the differential diagnosis of chyloptysis is to consider illnesses that can induce reflux of chyle into the bronchial tree. There are two mechanisms postulated: the first requires the presence of an abnormal communication between the bronchial tree and the lymphatic channels, and the second requires a bronchopleural fistula in the context of a chylous pleural effusion. Chyloptysis in adults should prompt assessment for evidence of lymphatic obstruction from trauma, radiation, and malignancy, and to exclude diseases with known association with chyloptysis, ie, lymphangioleiomyomatosis, yellow nail syndrome, or thoracic lymphangiectasis. A lymphangiogram is recommended to define the abnormality. In the case of lymphangiectasis, patients respond to either dietary modification and/or ligation of the thoracic duct.
乳糜痰是一种罕见的表现，伴随的呼吸道症状通常不具有特异性。认识到痰液的乳糜性质对于正确诊断至关重要，尤其是当乳糜痰不伴有乳糜性胸腔积液时。乳糜痰鉴别诊断的关键在于考虑可导致乳糜反流至支气管树的疾病。推测有两种机制：第一种需要支气管树与淋巴管之间存在异常交通，第二种需要在乳糜性胸腔积液的情况下存在支气管胸膜瘘。成人出现乳糜痰应促使评估是否有因创伤、放疗和恶性肿瘤导致的淋巴管阻塞证据，并排除与乳糜痰已知相关的疾病，即淋巴管平滑肌瘤病、黄甲综合征或胸段淋巴管扩张症。建议进行淋巴管造影以明确异常情况。对于淋巴管扩张症患者，可通过饮食调整和/或胸导管结扎来治疗。
