专题丨胸膜外间隙（EPS）的CT评估

闫美利

往期相关内容链接：

【呼吸系统-精品解剖图】

以上内容整理自：

TEACHING POINTS

■ At CT, the layers of the EPS more typically manifest as the intercostal stripe, a 1–2-mm-thick linear area of soft-tissue attenuation. The intercostal stripe represents a combination of the visceral pleura, parietal pleura, extrapleural adipose tissue, ETF, and IIM.

■ Chronic inflammation of the pleura can result in prolonged focal, mild immune stimulation that induces the proliferation of adipocytes adjacent to the inflamed tissue, with consequent increased extrapleural fat deposition.

■ In patients who present with symptoms of pleural effusion, increased attenuation of the EPS fat is a CT finding that suggests that the pleural effusion is an exudate, as this finding is typically absent in patients with transudative effusions.

■ The finding of internal displacement of a low-attenuating extrapleural adipose tissue layer is known as the extrapleural fat sign and helps to establish the diagnosis of extrapleural hematoma.

■ Lymphatic drainage of the parietal pleurae is complex and varies according to specific anatomic locations, with the pleurae draining into the EPS and local-regional nodes.

Conclusion

The EPS is an important anatomic region that is often overlooked at imaging. Chronic inflammation and/or infection, trauma, neoplastic disease, several infiltrative disorders, and splenosis can involve the EPS. Awareness of the normal anatomy of the EPS and recognition of the manifestations of disease arising in or extending into the EPS from the lung, pleura, chest wall, or other thoracic structures, as seen on thin-section CT images, can aid in the diagnosis and evaluation of thoracic diseases and help guide treatment.

感谢大家对熊猫的关注和支持！

你的阅读就是知识存在的意义！

你的经验就是医者仁心的基石！

查看原文 原文转载自微信公众号,著作权归作者所有

潘老师语音

脂肪间隙局部受推压，局部变窄，脂肪间隙有好多层？

紧贴胸膜有一层脂肪间隙

南边 潘军平韶关曲江区人民医院影 20:52

这两个间隙是不是一样？

平常心 20:48

sft是起源于脏层胸膜的

王崇军 20:49

@曹冠杰，济医附院 肋间肌之间也有脂肪组织，神经刚好在最内肋间肌与内肋间肌、外肋间肌之间啊

谢加平 20:50

脏层胸膜无神经支配

壁层胸膜才有神经支配

王崇军 20:52

@曹冠杰，济医附院 胸膜尾征应该是胸膜来源的佐证，该病例没有胸膜尾征，而是胸膜被掀起了，说明胸膜外侧的病灶推移胸膜向内移位了，

毛勤香 广西柳州龙潭医院影像 20:53

脏层和壁层胸膜间是没有脂肪的吧？如果脂肪间隙外推，说明顶起的是脏壁层胸膜2层，说明来自胸壁。

这个间隙内有占位，脂肪付如何推移？

来自于胸膜，他从外面推这个都有道理。但是如果在这个间隙中间，一条神经从这里过，这个病灶就在这个中间。那怎么办？

那他自然朝两侧推两侧推。肌肉外面的胸壁厉害，还是里面的那个皮下的那个胸膜厉害？那自然是外面的肌肉更强硬，对不对？

所以往往他这个推的内容偏内侧一点，

但是呢，我们看到这个明显跟胸膜之间有什么？胸膜尾征是什么？是指病灶朝胸膜腔外侵犯，否则引起刺激，引起胸膜增厚。他说，他们特别什么靠近病灶的区域是越来越厚的。越往外走越薄的吧。

如果病灶来自这个肌肉，脂肪一定内推

三层结构，红色胸膜，黄色间隙，绿色筋膜