Department of Digestive Diagnostic and Interventional Radiology, University Hospital Claude Huriez - Regional University Hospital Center, rue Michel Polonoski, 59037, Lille Cedex, France.
Abdom Radiol (NY). 2020 Nov;45(11):3589-3607. doi: 10.1007/s00261-020-02525-3.
The aim of the study is to describe the imaging features, complications and differential diagnoses of abdominal cystic lymphangiomas (ACLs).
ACLs are benign lymphatic malformations that mainly arise in the subperitoneal space and the retroperitoneum. The typical presentation of an ACL is a multilocular lesion with homogenous serous content, presenting a thin wall and septa, usually free from adjacent organ compression. Atypical findings, including fat or hemorrhagic content, septal calcifications and unilocular presentation, are not uncommon. Rarely, ACLs can be revealed by acute complications, such as infection, hemorrhage, intussusception, complications with a twisting mechanism (including torsion around its own pedicle) or spontaneous rupture, which can be diagnosed by imaging. Ultrasonography and CT are the most useful modalities in emergency situations. MRI performs best in the noninvasive characterization of cystic lesions. ACLs should be differentiated from normal anatomic structures (e.g., cisterna chyli) or pitfalls (e.g., ascites, extrapancreatic necrosis, lymphocele) that can simulate ACLs. Among other primary peritoneal cystic lesions, benign cystic mesothelioma can be difficult to differentiate from ACL. Some neoplastic peritoneal lesions may have cystic components or content that looks like fluid on imaging (such as mucinous or myxoid content) and be misdiagnosed as ACL. Nodular or thick enhancement of the wall or septa should then be considered worrisome features and should not suggest ACL. ACLs mostly require a simple follow-up. If treatment is necessary, percutaneous sclerotherapy is a safe and effective alternative to surgery.
Imaging, especially MRI, allows the noninvasive diagnosis of ACL and helps to exclude potential malignant differential diagnoses.
本研究旨在描述腹部囊性淋巴管瘤（ACLs）的影像学特征、并发症及鉴别诊断。
ACLs 是良性淋巴管畸形，主要发生在腹膜下腔和腹膜后。ACLs 的典型表现为多房性病变，囊内为均匀浆液性内容物，壁薄且有分隔，通常无邻近器官受压。不典型表现包括脂肪或出血性内容物、分隔钙化和单房性表现并不少见。罕见情况下，ACLs 可因急性并发症而显现，如感染、出血、肠套叠、扭转机制相关并发症（包括围绕自身蒂部扭转）或自发性破裂，这些并发症可通过影像学诊断。超声和 CT 是急诊情况下最有用的影像学检查方法。MRI 在囊性病变的无创性特征描述方面表现最佳。ACLs 应与正常解剖结构（如乳糜池）或易误诊为 ACL 的陷阱（如腹水、胰外坏死、淋巴囊肿）相鉴别。在其他原发性腹膜囊性病变中，良性囊性间皮瘤可能难以与 ACL 相鉴别。一些肿瘤性腹膜病变可能具有囊性成分或在影像学上表现为类似液体的内容物（如黏液或黏液样内容物），可能被误诊为 ACL。因此，壁或分隔的结节状或增厚强化应被视为令人担忧的特征，不应提示 ACL。ACLs 大多需要简单的随访。如果需要治疗，经皮硬化治疗是一种安全有效的手术替代方法。
影像学检查，特别是 MRI，可对 ACL 进行无创诊断，并有助于排除潜在的恶性鉴别诊断。
