Sumitani Ryohei, Higashi Kohei, Oura Masahiro, Maeda Yusaku, Yagi Hikaru, Sogabe Kimiko, Takahashi Mamiko, Harada Takeshi, Fujii Shiro, Miki Hirokazu, Abe Masahiro, Nakamura Shingen
Department of Hematology, Endocrinology and Metabolism, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan.
Department of Radiology and Radiation Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan.
Intern Med. 2025 Apr 15;64(8):1223-1228. doi: 10.2169/internalmedicine.4175-24. Epub 2024 Sep 27.
A 66-year-old woman was diagnosed with stage IV follicular lymphoma with a large tumor extending from the celiac artery to pelvis. Initial chemotherapy improved her lymphoma, but caused severe chylous ascites, requiring frequent paracentesis. Lymphoscintigraphy revealed radioisotope leakage into the abdominal cavity at the level of the renal hilum, indicating lymphatic vessel perforation. Lymphangiography with Lipiodol quickly resolved the chylous ascites. This case indicates that refractory chylous ascites with shrinking retroperitoneal lymphoma may require direct intervention in lymphatic vessels, and lymphangiography with Lipiodol may be effective not only as a tool for diagnosing lymphatic leakage sites but also as a treatment for lymphatic vessel damage.
一名66岁女性被诊断为IV期滤泡性淋巴瘤，有一个从腹腔动脉延伸至骨盆的巨大肿瘤。初始化疗改善了她的淋巴瘤，但引发了严重的乳糜性腹水，需要频繁进行腹腔穿刺术。淋巴闪烁造影显示放射性同位素在肾门水平漏入腹腔，提示淋巴管穿孔。使用碘油进行淋巴管造影迅速解决了乳糜性腹水问题。该病例表明，对于伴有腹膜后淋巴瘤缩小的难治性乳糜性腹水，可能需要对淋巴管进行直接干预，而使用碘油进行淋巴管造影不仅可作为诊断淋巴漏部位的工具，还可作为治疗淋巴管损伤的方法。
