Abstract
Lymphangiectasis of varying extent may be present in some cases of chronic pulmonary disease. Often the dilated lymphatic channels are not identified because pulmonary fibrosis and emphysema together with secondary inflammatory changes obscure the lymph vessel pathology. When chylothorax is associated with such chronic pulmonary pathology, attention may be drawn to the lymphatic system. The presence of a chylothorax is usually attributed to obstruction or injury of the thoracic duct, whereas in some cases chylous reflux into the lungs and pleurae via abnormal lymph channels in the lungs and pleurae as well as in the mediastinum may cause the chylothorax. In rare instances a patient may actually expectorate chylous fluid which seeps into the bronchi from the abnormal peribronchial lymphatics. A detailed analysis of reported cases together with some personal experience has demonstrated that pathological changes in the pulmonary and pleural lymphatic vessels are more common than is usually appreciated. The normal remarkable regenerative potential which is usually evident after experimental interruption of the lymphatics apparently is lacking in some humans due to genetic and other factors. Thus pathological changes, difficult to simulate experimentally, may be encountered. Lymphangiectasis is often found not to be limited to a single organ if complete studies of the lymphatic system are made.
Full text
PDFImages in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- BRANDT M. Uber Angiomyomatose der Lungen mit Wabenstruktur. Virchows Arch Pathol Anat Physiol Klin Med. 1952;321(6):585–598. doi: 10.1007/BF00956300. [DOI] [PubMed] [Google Scholar]
- BREWER L. A., 3rd Surgical management of lesions of the thoracic duct; the technic and indications for retroperitoneal anastomosis of the thoracic duct to the hemiazygos vein. Am J Surg. 1955 Aug;90(2):210–227. doi: 10.1016/0002-9610(55)90752-2. [DOI] [PubMed] [Google Scholar]
- BRZEK V., KREN V., BARTOS V. RETROGRADE LYMPHOGRAPHIE DES DUCTUS THORACICUS. Fortschr Geb Rontgenstr Nuklearmed. 1965 Feb;102:125–131. [PubMed] [Google Scholar]
- Cornog J. L., Jr, Enterline H. T. Lymphangiomyoma, a benign lesion of chyliferous lymphatics synonymous with lymphangiopericytoma. Cancer. 1966 Dec;19(12):1909–1930. doi: 10.1002/1097-0142(196612)19:12<1909::aid-cncr2820191219>3.0.co;2-r. [DOI] [PubMed] [Google Scholar]
- DELARUE J., DEPIERRE R., ROUJEAU J. Lymphangiectasie pulmonaire et pneumonie chyleuse. Sem Hop. 1950 Dec 25;26(95):4906–4917. [PubMed] [Google Scholar]
- Davies G. M. Lymph-casts of the bronchi. Br J Dis Chest. 1967 Jan;61(1):45–49. doi: 10.1016/s0007-0971(67)80021-4. [DOI] [PubMed] [Google Scholar]
- Freour P., Couraud L., Germouty J., Chomy P., Warin J. F., Mage J., Moukdarath N. Sur un chylothorax spontané de l'adulte. (Etude lymphographique et angiographique) J Fr Med Chir Thorac. 1966 Apr;20(3):281–291. [PubMed] [Google Scholar]
- GERSTEIN M. C., LINDSAY W. K., MCKENDRY J. B. Congenital defects of lymphatics in infancy. Pediatrics. 1957 Jan;19(1):21–35. [PubMed] [Google Scholar]
- GROVES L. K., EFFLER D. B. Primary chylopericardium. N Engl J Med. 1954 Mar 25;250(12):520–523. doi: 10.1056/NEJM195403252501206. [DOI] [PubMed] [Google Scholar]
- Hudspeth A. S., Miller H. S. Isolated (primary) chylopericardium. Diagnosis and surgical treatment. J Thorac Cardiovasc Surg. 1966 Apr;51(4):528–531. [PubMed] [Google Scholar]
- Humbert P., Zakarian S., Delmont J. P., Desnanot, Clérambault C., Picaut R. Etude de deux cas de chylothorax spontanés apparemment idiopathiques dont l'un avec entéropathie exsudative. J Fr Med Chir Thorac. 1966 Apr;20(3):357–369. [PubMed] [Google Scholar]
- JUSTIN BESANCON L., PEQUIGNOT H., GALEY J. J., RENAULT P., EVEN P. LYMPHANGIECTASIES PULMONAIRES DIFFUSES ACQUISES AVEC INSUFFISANCE RESPIRATOIRE ET CHYLOTHORAX. Sem Hop. 1963 May 14;39:1179–1190. [PubMed] [Google Scholar]
- KINMONTH J. B., TAYLOR G. W. The lymphatic circulation in lymphedema. Ann Surg. 1954 Feb;139(2):129–136. doi: 10.1097/00000658-195402000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- LAIPPLY T. C., SHERRICK J. C. Intrathoracic angiomyomatous hyperplasia associated with chronic chylothorax. Lab Invest. 1958 Jul-Aug;7(4):387–400. [PubMed] [Google Scholar]
- LIEBOW A. A., LORING W. E., FELTON W. L., 3rd The musculature of the lungs in chronic pulmonary disease. Am J Pathol. 1953 Sep-Oct;29(5):885–911. [PMC free article] [PubMed] [Google Scholar]
- LISTERUD M. B., HARKINS H. N., LOE R. H., THOMAS G. I., NYHUS L. M. Coincident bilateral chylothorax and chylous ascites. Am J Surg. 1958 Sep;96(3):438–444. doi: 10.1016/0002-9610(58)90943-7. [DOI] [PubMed] [Google Scholar]
- LOFFLER W., JACCARD G. Uber einen Fall von Chyloptoe mit pseudomiliarem Lungenbild. Schweiz Med Wochenschr. 1954 Nov 27;84(48):1335–1336. [PubMed] [Google Scholar]
- Lamotte M., Mathey J., Segrestaa J. M., Logeais Y. Lymphangiectasies pulmonaires diffuses acquises. Sem Hop. 1965 Oct 14;41(42):2364–2370. [PubMed] [Google Scholar]
- MADISON W. M., Jr, LOGUE B. Isolated (primary) chylopericardium due to anomalous communications with the thoracic duct, of unknown causation. Am J Med. 1957 May;22(5):825–830. doi: 10.1016/0002-9343(57)90132-8. [DOI] [PubMed] [Google Scholar]
- MILLER A. J., PICK R., KLINE I. K., KATZ L. N. THE SUSCEPTIBILITY OF DOGS WITH CHRONIC IMPAIRMENT OF CARDIAC LYMPH FLOW TO STAPHYLOCOCCAL VAGULAR ENDOCARDITIS. Circulation. 1964 Sep;30:417–424. doi: 10.1161/01.cir.30.3.417. [DOI] [PubMed] [Google Scholar]
- REINHARDT K. A propos d'un cas de lymphangiectasie pulmonaire. Radiol Clin. 1953 May;22(3):162–167. [PubMed] [Google Scholar]