Shima Takashi, Hara Takuya, Sato Keisuke, Kan Nobuhiko, Kinjo Tadamune
Department of Neonatology, Fukuoka Children's Hospital, 5-1-1, Kashiiteriha, Higashiku, Fukuoka, Fukukoka, 813-0017, Japan.
Department of Fetal Cardiology, Fukuoka Children's Hospital, 5-1-1, Kashiiteriha, Higashiku, Fukuoka, Fukuoka, 813-0017, Japan.
Radiol Case Rep. 2023 Feb 1;18(4):1471-1476. doi: 10.1016/j.radcr.2023.01.021. eCollection 2023 Apr.
A preschool male patient with an extensive cardiac surgical history developed refractory chylothorax after a total cavopulmonary connection. Neither lymphoscintigraphy nor single-photon emission computed tomography (SPECT)/computed tomography could identify the lymphatic system leakage sites. Non-contrast heavy T2-weighted magnetic resonance lymphangiography (MRL) was performed to visualize the lymphatic system. Nevertheless, distinguishing lymphatic ducts from other watery structures of the patient remained difficult. Therefore, non-contrast MRL and SPECT images were fused. This hybrid diagnostic tool elucidated the pathophysiology of the prolonged chylothorax; pulmonary lymphatic perfusion syndrome and illustrated the anatomical connection of the thoracic duct and an abnormally dilated lymphatic network in the neck and left hilar regions. Subsequent intranodal lymphangiography with ethiodized oil confirmed these findings. SPECT/MRL may become an alternative modality for revealing the mechanism of prolonged chylothorax by visualizing the lymphatic system when dynamic contrast-enhanced magnetic resonance lymphangiography is unavailable.
一名有广泛心脏手术史的学龄前男性患者在全腔肺连接术后出现难治性乳糜胸。淋巴闪烁造影和单光子发射计算机断层扫描（SPECT）/计算机断层扫描均无法确定淋巴系统漏出部位。进行了非增强重T2加权磁共振淋巴管造影（MRL）以显示淋巴系统。然而，将淋巴管与患者的其他含水结构区分开来仍然很困难。因此，将非增强MRL和SPECT图像融合。这种混合诊断工具阐明了持续性乳糜胸的病理生理学；肺淋巴灌注综合征，并显示了胸导管与颈部和左肺门区域异常扩张的淋巴网络之间的解剖连接。随后用乙碘油进行的结内淋巴管造影证实了这些发现。当无法进行动态对比增强磁共振淋巴管造影时，SPECT/MRL可能成为一种通过显示淋巴系统来揭示持续性乳糜胸机制的替代方法。
