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British Journal of Medicine and Medical Research, ISSN: 2231-0614,Vol.: 4, Issue.: 34 (01-10 December)

Original-research-article

Retrocrural Space Obliteration as CT Diagnostic Sign of Massive Chylothorax in Thoracic Injuries

 

Marco Matteoli1*, Marta Vincigurra1, Lara Cristiano1, Chiara De Dominicis1, Ilaria Mastroiacovo1, Gioia Papale1, Luca Tabbì2, Mohsen Ibrahim3, Giulio Maurizi3, Michele Rossi1 and Vincenzo David1

1Diagnostic and Interventional Radiology Unit, S. Andrea Hospital, Sapienza University, Rome, Italy.
2Department of Clinical and Molecular Medicine, Respiratory Science Unit, S. Andrea Hospital, Sapienza University, Rome, Italy.
3Department of Thoracic Surgery, S. Andrea Hospital, Sapienza University, Rome, Italy.

Article Information

Editor(s):

(1) Dr. Salomone Di Saverio, Emergency Surgery Unit, Department of General and Transplant Surgery, S. Orsola Malpighi University Hospital, Bologna, Italy.

Reviewers:

(1) Graziella Di Grezia, Second University of Naples, Italy.

(2) Damyanti Agrawal, Banaras Hindu University, India.

Complete Peer review History: http://www.sciencedomain.org/review-history/5465

Abstracts

Purpose: Blunt traumatic chylothorax could be distinguished in CT (Computer Tomography) scan as low attenuated fluid, due to chylomicrons inside, however blood intermixture in chylous effusion could make densitomery higher and hide chylothorax, due to the possible presence of an underlying hemothorax. The objective of the study is to demonstrate the specificity of retrocrural space obliteration, as additional CT sign to quickly identify and treat chylothorax.
Materials and Methods: This retrospective study was undertaken since May 2012 until May 2013 and included patients scheduled for MDCT (Multi Detector CT) scan before a thoracentesis procedure diagnostic for hemothorax and chylothorax. Were used as a controls, MDCT scans performed for thoracic or thoracic-abdominal trauma, or after a thoracic surgery procedure.
Results: Comparison of CT findings revealed significant difference in densitometry between the two groups of effusions (P=0,003), a difference in inability of visualization of retrocrural space (P=0,0002) and cisterna chily (P=0,0009). Inability to observe thoracic duct was not different between the two groups (P=0,8805).
Conclusion: Negative density (-16,7+8HU) in effusions, due to the presence of fat inside, was usually observed in almost 6 anterior regions or at least 2 upper anterior regions and it’s the best way to distinguish a chylo-thorax to hemo-thorax. Most accurate CT scan differentiation between post traumatic massive bloody and chylous leakage can be done after assessment of a lower densitometry of effusion and inability in observing chylous structures and fat in retrocrural space due to chylous leakage inside.

Keywords :

Chylothorax; chyloperitoneum; CT scan; thoracic duct; cisternaa Chyli; retro-crural space.

Full Article - PDF    Page 5335-5347

DOI : 10.9734/BJMMR/2014/12302

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