Imaging Findings of Thoracic Lymphatic Abnormalities

Area of Science:

• Thoracic lymphatic system imaging
• Diagnostic radiology
• Interventional radiology

Background:

• The lymphatic system is vital for fluid balance but is susceptible to thoracic diseases (surgery, malignancy, heart failure).
• Imaging lymphatic vessels is difficult due to their small size, necessitating optimized and developing imaging methods.
• Conventional lymphangiography has been the gold standard, but other modalities are also used.

Purpose of the Study:

• To review thoracic lymphatic anatomy.
• To describe imaging manifestations of lymphatic abnormalities in pulmonary parenchyma, pleural space, and mediastinum.
• To discuss interventional radiology treatments for chylothorax.

Main Methods:

• Review of conventional lymphangiography, CT, MRI (noncontrast and contrast-enhanced), and lymphoscintigraphy.
• Analysis of imaging findings in pulmonary parenchyma (interlobular septal thickening, lymphatic flow reversal), pleural space (chylous/nonchylous pleural effusion), and mediastinum (thoracic duct leak, lymphatic malformations, lymphangiectasis).
• Discussion of management strategies for chylothorax, including conservative, medical, surgical, and interventional radiology approaches.

Main Results:

• Lymphatic abnormalities present with characteristic findings in the lungs, pleura, and mediastinum.
• Imaging modalities can effectively demonstrate these abnormalities, aiding in treatment planning.
• Chylothorax management involves a spectrum of treatments, with interventional radiology playing a role.

Conclusions:

• Radiologists must be familiar with thoracic lymphatic imaging findings for accurate diagnosis.
• Understanding these imaging manifestations is key to guiding appropriate management of lymphatic abnormalities and chylothorax.
• Continued optimization and development of lymphatic imaging methods are essential.