Zironi G, Cavalli G, Casali A, Piscaglia F, Gaiani S, Siringo S, Sofia S, Venturoli N, Bolondi L
Istituto di Clinica Medica e Gastroenterologia, Università di Bologna, Italy.
AJR Am J Roentgenol. 1995 Oct;165(4):863-6. doi: 10.2214/ajr.165.4.7676982.
Our study assessed the feasibility of detecting and measuring by sonography the diameter of the thoracic duct in healthy subjects and in patients with cirrhosis and portal hypertension. We also evaluated the relationship of thoracic duct size with age and with clinical, endoscopic, and sonographic signs of portal hypertension.
The left supraclavicular area of 24 patients with cirrhosis and 23 healthy subjects was examined with high-frequency probes using transverse and oblique scans to visualize the distal end of the thoracic duct. All patients with cirrhosis, diagnosed by liver biopsy or clinical and biochemical data, had endoscopic or sonographic signs of portal hypertension. The severity of the liver disease was determined by Child-Pugh's criteria; the diameter of portal vessels and the size of esophageal varices were also considered.
The thoracic duct was visualized in 19 of 24 patients with cirrhosis and in 18 of 23 control subjects (percent of visualization was 79% and 78%, respectively). The diameter of the duct was larger in patients with cirrhosis than in healthy subjects (3.1 +/- 1.2 mm versus 1.9 +/- 0.5 mm; p < .0001), but no relationship was found among clinical, endoscopic, and sonographic signs of portal hypertension. A direct relationship between age and the size of the thoracic duct was found only among healthy subjects.
This is the first report of the sonographic visualization of the distal end of the thoracic duct. Its diameter is small in healthy young subjects, whereas in patients with cirrhosis its increased diameter seems to be associated only with the presence of portal hypertension and not with its severity.
我们的研究评估了通过超声检测和测量健康受试者以及肝硬化和门静脉高压患者胸导管直径的可行性。我们还评估了胸导管大小与年龄以及门静脉高压的临床、内镜和超声征象之间的关系。
使用高频探头对24例肝硬化患者和23例健康受试者的左锁骨上区域进行横切和斜切扫描，以观察胸导管的远端。所有经肝活检或临床及生化数据确诊为肝硬化的患者均有门静脉高压的内镜或超声征象。根据Child-Pugh标准确定肝病的严重程度；还考虑门静脉血管直径和食管静脉曲张大小。
24例肝硬化患者中有19例观察到胸导管，23例对照受试者中有18例观察到胸导管（观察到的百分比分别为79%和78%）。肝硬化患者的胸导管直径大于健康受试者（3.1±1.2mm对1.9±0.5mm；p<0.0001），但门静脉高压的临床、内镜和超声征象之间未发现相关性。仅在健康受试者中发现年龄与胸导管大小之间存在直接关系。
这是关于胸导管远端超声显像的首份报告。在健康年轻受试者中其直径较小，而在肝硬化患者中其直径增加似乎仅与门静脉高压的存在有关，与严重程度无关。
