Das kombinierte mediastinale und retroperitoneale zystische Lymphangiom als seltene Ursache rezidivierender Pleuraergüsse

Zusammenfassung

Wir berichten über eine 71-jährige Patientin mit spontan aufgetretenen rezidivierenden linksseitigen Chylothoraces zunächst unklarer Dignität. Anhand von schnittbildgebenden Verfahren, MRT, Lymphszintigrafie und CT-gesteuerter Biopsie konnte die Diagnose eines kombinierten mediastinalen und retroperitonealen zystischen Lymphangioms gestellt werden. Neben einer Literaturübersicht zu zystischen Lymphangiomen werden in vorliegendem Fallbericht auch differenzialdiagnostische Überlegungen zur Genese von Chylothoraces diskutiert.

Abstract

We report on a 71-year-old female patient with spontaneous unilateral recurrent chylothoraces – at first glance with no apparent cause. After performing CT, MRI, lymphatic scintigraphy, and CT-guided biopsy, we were able to establish the diagnosis of a combined mediastinal and retroperitoneal cystic lymphangioma. Together with a review of the literature concerning cystic lymphangioma, we also discuss possible differential diagnoses of chylothoraces.

• Literatur

• 1 Cutillo DP, Swayne LC, Cucco J et al. CT and MR imaging in cystic abdominal lymphangiomatosis. J Comput Assist Tomogr 1989; 13: 534-536
• 2 Gray G, Fried K, Iraci J. Cystic lymphangioma of the pancreas: CT and pathologic findings. Abdom Imaging 1998; 23: 78-80
• 3 de Perrot M, Rostan O, Morel P et al. Abdominal lymphangioma in adults and children. Br J Surg 1998; 85: 395-397
• 4 Koenig TR, Loyer EM, Whitman GJ et al. Cystic lymphangioma of the pancreas. AJR Am J Roentgenol 2001; 177: 1090
• 5 Krahe T, Schneider B, Schmidt C. Cystic lymphangioma of the greater omentum. Fortschr Röntgenstr 1985; 143: 476-478
• 6 Power D. Remarks on Cystic Lymphangioma in Childhood: Its Differential Diagnosis and Treatment. Br Med J 1896; 1: 1189-1191
• 7 Bhavsar T, Saeed-Vefa D, Harbinson S et al. Retroperitoneal cystic lymphangioma in an adult: A case report and review of the literature. World J Gastrointest Pathophysiol 2010; 1: 171-176
• 8 Hancock BJ, St-Vil D, Luks FL et al. Complications of lymphangiomas in children. J Pediatr Surg 1992; 27: 220-224 ; discussion 224-226
• 9 Roisman I, Manny J, Fields S et al. Intra-abdominal lymphangioma. Br J Surg 1989; 76: 485-489
• 10 Sharkey AJ, Rao JN. The successful use of octreotide in the treatment of traumatic chylothorax. Tex Heart Inst J 2012; 39: 428-430
• 11 Pui MH, Yueh TC. Lymphoscintigraphy in chyluria, chyloperitoneum and chylothorax. J Nucl Med 1998; 39: 1292-1296
• 12 Goh KL, Tan HW, Loh TG et al. Chylothorax due to filariasis – a case report. Singapore Med J 1986; 27: 173-176
• 13 Gorham LW, Stout AP. Massive osteolysis (acute spontaneous absorption of bone, phantom bone, disappearing bone); its relation to hemangiomatosis. J Bone Joint Surg Am 1955; 37-A: 985-1004
• 14 Kuhlman JE, Bouchardy L, Fishman EK et al. CT and MR imaging evaluation of chest wall disorders. Radiographics 1994; 14: 571-595
• 15 Jeung MY, Gasser B, Gangi A et al. Imaging of cystic masses of the mediastinum. Radiographics 2002; 22: 79-93
• 16 Correia FM, Seabra B, rego A et al. Cystic lymphangioma of the mediastinum. J Bras Pneumol 2008; 34: 982-984
• 17 Tecce PM, Fishman EK, Kuhlman JE. CT evaluation of the anterior mediastinum: spectrum of disease. Radiographics 1994; 14: 1404
• 18 Bonhomme A et al. Cystic lymphangioma of the retroperitoneum. Clin Radiol 2001; 56: 156-158
• 19 Dong A, Wang Y, Zuo C. F-18 FDG uptake in a retroperitoneal cystic lymphangioma mimicking malignancy. Clin Nucl Med 2012; 37: e154-156
• 20 Fonkalsrud EW. Congenital malformations of the lymphatic system. Semin Pediatr Surg 1994; 3: 62-69
• 21 Subotic U, Hosie S, Waag KL et al. [Treatment of lymphangiomas with picibanil in the first year of life]. Klin Padiatr 2008; 220: 248-252
• 22 Kilic D, Sahin E, Gulcan O et al. Octreotide for treating chylothorax after cardiac surgery. Tex Heart Inst J 2005; 32: 437-439