Contribution of Lymphoscintigraphy to the Diagnosis of Lymphoedema of the Extremities

Overview

Lymphoscintigraphy is a simple non-invasive method used in adult patients for the diagnosis of primary and secondary lymphoedema of the lower and upper extremities. It provides basic information on the morphology and functional state of the superficial lymphatic system and in examinations of the lower extremities it makes possible evaluation of lymphatic drainage at rest and after burdening of the extremities. It requires only s.c. administration of a 99mTc labelled colloid radiopharmaceutical preparation which is subsequently conveyed by the lymphatic vessels into regional nodes.Between June 1998 and August 2000 lymphoscintigraphy of the lower extremities was performed in 9 patients age 11 months to 14 years (mean 9 years) with suspected primary lymphoedema of the lower extremities and in one patient with suspected hemihypertrophy or primary lymphoedema of the lower extremity. In all 9 patients with suspected primary lymphoedema lymphoscintigraphy revealed pathological features of the lymphatic system, of the affected limb. The most frequent manifestation of primary lymphoedema was congestion of the radiopharmaceutical preparation at the site of administration, lack of visualization of the lymphatic vessels and lymph nodes or poor visualization. Only in one patient the passage of the radiopharmaceutical preparation through the subcutaneous layer of the extremity (dermal backflow) was observed. In the patient with suspected hemihypertrophy the lymphoscintigraphic finding on the affected extremity was normal. In a patient with Turner’s syndrome in addition to lymphoedema of the lower extremities also lymphoedema of the upper extremity was found.At present lymphoscintigraphy is the method of first choice in the diagnosis of lymphoedema of the lower extremities. Based on our initial experience it is a suitable method also for the diagnosis of lymphoedema of child patients. Examination of a larger group of patients is, however, the prerequisite for elaboration of normal values which will make more accurate diagnosis of lymphoedema possible, in particular milder lymphoedema.

Key words:
lymphoedema, lymphoscintigraphy, Nonne-Milroy syndrome, Meige’s syndrome