Avila Nilo A, Dwyer Andrew J, Rabel Antoinette, DeCastro Rosamma M, Moss Joel
Department of Diagnostic Radiology, Warren G. Magnuson Clinical Center, Bldg. 10, Rm. 1C-660, 10 Center Dr., MSC 1182, Bethesda, MD 20892-1182, USA.
AJR Am J Roentgenol. 2006 Apr;186(4):1007-12. doi: 10.2214/AJR.04.1912.
The objective of our article was to describe the spectrum and frequency of pleural abnormalities on CT in patients with lymphangioleiomyomatosis (LAM) and the pleural findings associated with different types of pleurodesis (talc, mechanical, and chemical) performed to treat the complications of pleural disease in these patients.
Two hundred fifty-eight patients with LAM underwent CT of the chest. Pleural abnormalities assessed included pleural thickening, presence of a pleural mass, areas of high attenuation, effusion, and pneumothorax. In patients who had had pleurodesis, the CT findings were correlated with the type of procedure performed.
One hundred thirty-three (52%) of 258 patients had pleurodesis (unilateral, 68/133; bilateral, 65/133). Pleural abnormalities were more common in patients who had pleurodesis (101/133, 76%) than in those who had not (47/125, 38%) and were more prevalent on the operated side than on the unoperated side of those 68 patients who had unilateral pleurodesis. The frequencies of findings for the group without pleurodesis versus the group with pleurodesis were pleural thickening (26% vs 65%), effusion (10% vs 13%), loculated effusion (2.4% vs 11%), pneumothorax (1.6% vs 10%), areas of high attenuation (1.6% vs 23%), and mass (0.8% vs 14%), respectively. Areas of high attenuation in the pleura were present in all types of pleurodesis (mechanical, 8%; chemical, 13%; talc, 40%) and in two patients who had had repeated thoracentesis or pleurectomy. Pleural masses were present in patients who had had all types of pleurodesis (mechanical, 10%; chemical, 9%; talc, 24%) and in one patient who had had thoracentesis and thoracostomy; the masses commonly enhanced and did not change in size over time.
Pleural abnormalities are common in patients with LAM as complications of the disease itself and as sequelae of pleurodesis and other pleura manipulations. Pneumothorax and pleural effusion result from the underlying pathophysiology of LAM, whereas areas of high attenuation and masses develop after all types of pleurodesis and other manipulations of the pleura (i.e., thoracentesis, thoracostomy).
我们这篇文章的目的是描述淋巴管平滑肌瘤病（LAM）患者胸部CT上胸膜异常的范围和频率，以及与为治疗这些患者胸膜疾病并发症而进行的不同类型胸膜固定术（滑石粉、机械性和化学性）相关的胸膜表现。
258例LAM患者接受了胸部CT检查。评估的胸膜异常包括胸膜增厚、胸膜肿块、高密度区、胸腔积液和气胸。在接受胸膜固定术的患者中，将CT表现与所施行的手术类型相关联。
258例患者中有133例（52%）接受了胸膜固定术（单侧，68/133；双侧，65/133）。胸膜异常在接受胸膜固定术的患者中（101/133，76%）比未接受胸膜固定术的患者中（47/125，38%）更常见，并且在68例接受单侧胸膜固定术患者的手术侧比未手术侧更普遍。未接受胸膜固定术组与接受胸膜固定术组的检查结果频率分别为胸膜增厚（26%对65%）、胸腔积液（10%对13%）、包裹性胸腔积液（2.4%对11%）、气胸（1.6%对10%）、高密度区（1.6%对23%）和肿块（0.8%对14%）。胸膜高密度区在所有类型的胸膜固定术中均有出现（机械性，8%；化学性，13%；滑石粉，40%），并且在2例接受反复胸腔穿刺或胸膜切除术的患者中也有出现。胸膜肿块在接受所有类型胸膜固定术的患者中均有出现（机械性，10%；化学性，9%；滑石粉，24%），并且在1例接受胸腔穿刺和胸腔造口术的患者中也有出现；这些肿块通常有强化，且大小随时间无变化。
胸膜异常在LAM患者中很常见，是疾病本身的并发症以及胸膜固定术和其他胸膜操作的后遗症。气胸和胸腔积液是由LAM的潜在病理生理学导致的，而高密度区和肿块是在所有类型的胸膜固定术和其他胸膜操作（即胸腔穿刺、胸腔造口术）后出现的。
