Learning objectives
To revisit the basics of lymphoedema
To appreciate normal findings on lymphoscintigraphy
To review examples of lymphoedema on lymphoscintigraphy
Background
The lymphatic system transports tissue fluid back into blood circulation. Normal lymphatic drainage from the extremities occurs via valveless lymphatic capillaries located in the dermis, which drain to valve-containing lymphatic vessels in the subcutaneous soft tissues, thereafter to deep lymphatic tracts and lymph nodes in regional drainage basins before passing into the lymphatic ducts of the trunk. [Fig 1]
Lymphoedema is defined as the chronic, progressive accumulation of lymph in extracellular spaces. It most commonly involves the lower limbs and genitals, but may also affect...
Findings and procedure details
Table 3 details the typical findings expected on lymphoscintigraphy for a normal study and in patients with primary lymphoedema. [Table 3]
Figures 4 and 5 demonstrate normal findings on lymphoscintigraphy. [Fig 4] [Fig 5]
Figures 6 to 14 demonstrate a spectrum of findings in lymphoedema. The clinical history and pertinent findings are detailed in the cases. [Fig 6] [Fig 7] [Fig 8] [Fig 9] [Fig 10] [Fig 11] [Fig 12] [Fig 13] [Fig 14]
Conclusion
Primary lymphoedema is a rare entity with significant clinical and psychosocial morbidity. Radionuclide lymphoscintigraphy plays a key role in the investigation of patients with suspected primary lymphoedema. Herein we have reviewed normal findings on lymphoscintigraphy, followed by a range of abnormal findings in patients who presented with primary lymphoedema.
Personal information and conflict of interest
L. Chang:
Nothing to disclose
H. M. Chang:
Nothing to disclose
R. Norman:
Nothing to disclose
S. Heenan:
Nothing to disclose
References
All images with thanks to Department of Radiology, St George’s University Hospital NHS Trust, London, UK 2023
[1] Lymphedema: Pathogenesis and Novel Therapies. Joseph H. Dayan, Catherine L. Ly, Raghu P. Kataru, Babak J. Mehrara. Annual Review of Medicine 2018 69:1, 263-276.
[2] Using Lymphoscintigraphy to Evaluate Suspected Lymphedema of the Extremities. Mariam Moshiri, Douglas S. Katz, Marvin Boris and Elizabeth Yung. American Journal of Roentgenology. 2002;178: 405-412.
[3] Primary Lymphedema: Clinical Features and Management in 138 Pediatric Patients. Schook, Carolyn C. B.A.; Mulliken, John...