Reetz Jennifer A, Suran Jantra N, Zwingenberger Allison L, Stefanovski Darko
Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, 19014.
Department of Surgical and Radiological Sciences, University of California Davis School of Veterinary Medicine, Davis, CA, 95616.
Vet Radiol Ultrasound. 2019 May;60(3):289-299. doi: 10.1111/vru.12706. Epub 2018 Dec 17.
Thoracic CT may be used in the workup of patients with pleural effusion. In humans, certain pleural features on CT aid in diagnosing an underlying cause for pleural effusion, whereas this is not well studied in veterinary medicine. This retrospective cross-sectional analytical study assessed pleural and other intrathoracic abnormalities on CT in dogs and cats with pleural effusion and explored potential discriminatory features between effusion types. Eighty-nine dogs and 32 cats with pleural cytology and/or histopathology were categorized into malignant pleural disease (15 dogs and 11 cats), pyothorax (34 dogs and 7 cats), chylothorax (20 dogs and 11 cats), transudative (11 dogs and 2 cats), and hemorrhagic effusion (9 dogs and 1 cat). Multivariable logistic regression analysis comparing malignancy to other effusions found that older patient age (dogs: odds ratio 1.28, P = 0.015; cats: odds ratio 1.53, P = 0.005), nodular diaphragmatic pleural thickening (dogs: odds ratio 7.64, P = 0.021; cats: odds ratio 13.67, P = 0.031), costal pleural masses (dogs: odds ratio 21.50, P = 0.018; cats: odds ratio 32.74, P = 0.019), and pulmonary masses (dogs: odds ratio 44.67, P = 0.002; cats: odds ratio 18.26, P = 0.077) were associated with malignancy. In dogs, any costal pleural abnormality (odds ratio 47.55, P = 0.002) and pulmonary masses (odds ratio 10.05, P = 0.004) were associated with malignancy/pyothorax, whereas any costal pleural abnormality (odds ratio 0.14, P = 0.006) and sternal lymphadenopathy (odds ratio 0.22, P = 0.040) were inversely associated with transudates. There were, however, many overlapping abnormalities between effusion types, so further diagnostic testing remains important for diagnosis.
胸部CT可用于胸腔积液患者的检查。在人类中，CT上的某些胸膜特征有助于诊断胸腔积液的潜在病因，而在兽医学中对此研究较少。这项回顾性横断面分析研究评估了患有胸腔积液的犬猫CT上的胸膜及其他胸腔内异常情况，并探讨了不同类型积液之间潜在的鉴别特征。89只犬和32只猫进行了胸腔细胞学和/或组织病理学检查，被分为恶性胸膜疾病（15只犬和11只猫）、脓胸（34只犬和7只猫）、乳糜胸（20只犬和11只猫）、漏出液（11只犬和2只猫）和血性积液（9只犬和1只猫）。多变量逻辑回归分析比较恶性肿瘤与其他积液发现，老年患者（犬：比值比1.28，P = 0.015；猫：比值比1.53，P = 0.005）、结节性膈胸膜增厚（犬：比值比7.64，P = 0.021；猫：比值比13.67，P = 0.031）、肋胸膜肿块（犬：比值比：21.50，P = 0.018；猫：比值比32.74，P = 0.019）和肺部肿块（犬：比值比44.67，P = 0.002；猫：比值比18.26，P = 0.077）与恶性肿瘤相关。在犬中，任何肋胸膜异常（比值比47.55，P = 0.002）和肺部肿块（比值比10.05，P = 0.004）与恶性肿瘤/脓胸相关，而任何肋胸膜异常（比值比0.14，P = 0.006）和胸骨淋巴结病（比值比0.22，P = 0.040）与漏出液呈负相关。然而，不同类型积液之间存在许多重叠的异常情况，因此进一步的诊断测试对诊断仍然很重要。
