Principal Author and Panel Vice-Chair (Vascular Imaging), University of Michigan Health System, Ann Arbor, Michigan.
Research Author, University of Michigan, Ann Arbor, Michigan.
J Am Coll Radiol. 2017 May;14(5S):S118-S126. doi: 10.1016/j.jacr.2017.02.025.
Chylothorax is an uncommon but serious medical condition, which arises when intestinal lymphatic fluid leaks into the pleural space. Treatment strategies depend on the daily output and underlying etiology, which may be due to direct injury to lymphatic vessels or a nontraumatic disorder. Chest radiographs confirm the presence of pleural fluid and lateralize the process. In the setting of direct injury, lymphangiography can often be both diagnostic and facilitate a minimally invasive attempt at therapy. CT and MRI in this setting may be appropriate for cases when lymphangiography is not diagnostic. When the etiology is nontraumatic or unknown, CT or MRI can narrow the differential diagnosis, and lymphangiography is useful if a minimally invasive approach to treatment is desired. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
乳糜胸是一种不常见但严重的医学病症，是由于肠道淋巴液漏入胸腔引起的。治疗策略取决于每日的输出量和潜在病因，可能是由于淋巴管直接损伤或非创伤性疾病。胸部 X 光片可确认胸腔积液的存在并确定病变的位置。在直接损伤的情况下，淋巴管造影术通常既具有诊断价值，又可方便进行微创治疗尝试。在淋巴管造影术无法诊断的情况下，CT 和 MRI 可能适用于这种情况。如果病因是非创伤性或未知的，则 CT 或 MRI 可以缩小鉴别诊断的范围，并且如果需要微创治疗方法，则淋巴管造影术是有用的。美国放射学院适宜性标准是针对特定临床情况的循证指南，每年由多学科专家小组进行审查。指南的制定和修订包括对同行评议期刊上的现有医学文献进行广泛分析，并应用成熟的方法（RAND/UCLA 适宜性方法和推荐评估、制定和评估分级或 GRADE）来评估特定临床情况下的影像学和治疗程序的适宜性。在缺乏证据或证据不确定的情况下，专家意见可以补充现有证据，以推荐影像学或治疗。
