胸腔积液相关的急性胰腺炎：MDCT 表现及解剖基础。

Acute pancreatitis associated with pleural effusion: MDCT manifestations and anatomical basis.

机构信息

Department of Radiology, The First Affiliated Hospital of Henan University, Kaifeng, Henan, China.

Department of Gastrointestinal Medicine, The First Affiliated Hospital of Henan University, Kaifeng, Henan, China.

出版信息

Technol Health Care. 2024;32(3):1657-1666. doi: 10.3233/THC-230702.

DOI:10.3233/THC-230702

PMID:38108366

Abstract

BACKGROUND

Acute pancreatitis (AP) is a severe condition with complications that can impact multiple organ systems throughout the body. Specifically, the diffusion of peripancreatic effusion to the pleural cavity is a significant phenomenon in AP. However, its pathways and implications for disease severity are not fully understood.

OBJECTIVE

This study aims to investigate the anatomical routes of peripancreatic effusion diffusion into the pleural cavity in patients with AP and to analyze the correlation between the severity of pleural effusion (PE) and the computed tomography severity index (CTSI) and acute physiology and chronic health evaluation II (APACHE II) scoring system.

METHODS

119 patients with AP admitted to our institution were enrolled in this study (mean age 50 years, 74 male and 45 female). Abdominal CT was performed, and the CTSI and APACHE II index were used to evaluate the severity of the AP, Meanwhile, the prevalence and semiquantitative of PE were also mentioned. The anatomical pathways of peripancreatic effusion draining to pleural were analyzed. Finally, the correlation relationship between the severity of AP and the PE was analyzed.

RESULTS

In 119 patients with AP, 74.8% of patients had PE on CT. The anatomic pathways of peripancreatic effusion draining to pleural included esophageal hiatus in 33.7% of patients, aortic hiatus in 6.7% of patients and inferior vena cava hiatus in 3.37% of patients. The rating of PE on CT was correlated with CTSI scores (r= 0.449, P= 0.000) and was slightly correlated with the APACHE II scores (r= 0.197, P= 0.016).

CONCLUSION

PE is a common complication of AP, which can be caused by anatomic pathways such as diaphragmatic hiatus. Due to its correlation with the CTSI score, the PE may be a supplementary indicator in determining the severity of AP.

摘要

背景

急性胰腺炎（AP）是一种严重的疾病，其并发症可影响全身多个器官系统。具体来说，胰周渗出液扩散至胸腔是 AP 的一个重要现象。然而，其扩散途径及其对疾病严重程度的影响尚不完全清楚。

目的

本研究旨在探讨 AP 患者胰周渗出液扩散至胸腔的解剖途径，并分析胸腔积液（PE）严重程度与 CT 严重指数（CTSI）和急性生理学与慢性健康评估 II（APACHE II）评分系统之间的相关性。

方法

纳入我院收治的 119 例 AP 患者（平均年龄 50 岁，男 74 例，女 45 例）。行腹部 CT 检查，采用 CTSI 和 APACHE II 指数评估 AP 的严重程度，同时描述 PE 的发生率和半定量。分析胰周渗出液引流至胸腔的解剖途径。最后，分析 AP 严重程度与 PE 的相关性。

结果

在 119 例 AP 患者中，74.8%的患者 CT 显示有 PE。胰周渗出液引流至胸腔的解剖途径包括食管裂孔 33.7%，主动脉裂孔 6.7%，下腔静脉裂孔 3.37%。CT 上 PE 的评分与 CTSI 评分呈正相关（r=0.449，P=0.000），与 APACHE II 评分呈弱相关（r=0.197，P=0.016）。