Adachi Hideki, Hashimoto Toshio, Komiyama Manabu, Miyao Yoshiko, Sudou Akihiko, Nakamura Hiroyuki, Matuoka Takeshi
Fifth Department of Internal Medicine, Tokyo Medical University, Japan.
Nihon Kokyuki Gakkai Zasshi. 2004 Jan;42(1):80-3.
A 28-year-old woman was admitted to our hospital complaining of chest pain and dyspnea. Chest radiographs showed left pleural effusion. The effused fluid obtained by thoracocentesis was milky, and so chylothorax was diagnosed. A high-resolution chest CT (HRCT) scan demonstrated diffuse multiple cystic lesions, which were undetectable by conventional CT. An abdominal CT scan showed a retroperitoneal tumor. Since the effusion was resistant to conservative therapy, we performed clipping of the thoracic duct under the diaphragm. Since the effusion disappeared after continuous aspiration, 10 KE of OK-432 was administered into the pleural cavity, and the chylorrhea disappeared. The clinical diagnosis, based on the biopsy of the abdominal tumor, was lymphangioleiomyomatosis. Chylothorax developing from lymphangioleiomyomatosis is rare in Japan. However, we must consider the possibility of lymphangioleiomyomatosis in patients with chylothorax, and always perform chest HRCT.
一名28岁女性因胸痛和呼吸困难入院。胸部X线片显示左侧胸腔积液。胸腔穿刺抽取的积液呈乳白色，因此诊断为乳糜胸。高分辨率胸部CT（HRCT）扫描显示弥漫性多发囊性病变，传统CT无法检测到。腹部CT扫描显示腹膜后肿瘤。由于积液对保守治疗无效，我们在膈肌下对胸导管进行了结扎。由于持续抽吸后积液消失，向胸腔内注入10KE的OK-432，乳糜漏消失。根据腹部肿瘤活检的临床诊断为淋巴管平滑肌瘤病。在日本，由淋巴管平滑肌瘤病引起的乳糜胸很少见。然而，我们必须考虑乳糜胸患者发生淋巴管平滑肌瘤病的可能性，并始终进行胸部HRCT检查。
