Value of one additional injection at the root of the limb in the lymphoscintigraphic evaluation and management of primary and secondary lower-limb lymphedemas
| Autor: | Pierre Bourgeois, Olivier Leduc |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
Psychologie appliquée 030218 nuclear medicine & medical imaging Diagnostic Radiology 0302 clinical medicine Abdomen Medicine and Health Sciences Edema Lymphedema Child Musculoskeletal System Physiotherapy Routes of Administration Aged 80 and over Multidisciplinary integumentary system Feet Radiology and Imaging Sciences bio-médicales et agricoles Middle Aged medicine.anatomical_structure Lymphatic system Lower Extremity 030220 oncology & carcinogenesis Medicine Technetium Tc 99m Pentetate Legs Female Radiology Lymph Anatomy Biologie Lymphoscintigraphy Research Article Adult Lymphatic edema medicine.medical_specialty Superficial Lymphatic Vessel Adolescent Imaging Techniques Science Inguinal Canal Research and Analysis Methods Lower limb Injections Pelvis 03 medical and health sciences Young Adult Signs and Symptoms Intradermal Injections Diagnostic Medicine medicine Humans In patient Gluteal muscles Technetium Tc 99m Aggregated Albumin Skeleton Aged Lymphatic Vessels Retrospective Studies Pharmacology business.industry Biology and Life Sciences body regions Health Care Body Limbs Lymph Nodes Clinical Medicine business |
| Zdroj: | PLoS ONE PloS one, 16 (7 July PLoS ONE, Vol 16, Iss 7, p e0253900 (2021) |
| ISSN: | 1932-6203 |
| Popis: | Introduction The classical lymphoscintigraphic investigations of lower-limb lymphatic edema [LLLE] sometimes reveal either no or few lymph nodes [LNs] at the root of the limb[s] and/or in the abdomen. The aim of the present paper is to report the results of performing one additional injection at the root of the edematous limb[s] to force the visualization of the LNs and/or to demonstrate the collateral lymphatic pathways in such patients. Methods and findings We retrospectively reviewed our database and found 99 patients [44 primary LLLE with 47 limbs injected and 55 with LLLE secondary to treatments for cancer with 64 limbs injected] where such an additional injection had been performed. In the 43 LLLE patients where no LNs were seen at the end of the classical exam [15 primary LLLE and 28 secondary LLLE], the extra injection showed lymphatic drainage toward LN[s] in all except 3 and when at least one LN was seen, the injection showed lymphatic drainage in every case toward the same ipsilateral [inguinal and/or iliac] LNs [as shown by the classical injection] and/or toward additional LNs. In 40.7% of patients, we observed one or more additional lymphatic pathways: prepubic superficial lymphatic vessels [LV] crossing the midline anteriorly toward contralateral inguinal LNs in 21 [18.9%], “posterior” LV [toward contralateral inguinal LNs and/or ipsi- or contralateral lumbo-aortic and/or para-renal LNs] in 14 [12.6%], but deep LV toward the ipsilateral common iliac LNs passing between the gluteal muscles in 32 [28.8%]. Conclusion Our work pinpoints one limitation of classical bipedal radionuclide lymphangiography. In patients with primary and secondary LLLE where inguinal and/or iliac LNs cannot be seen on bipedal radionuclide lymphangiography, this additional injection reveals the true lymphonodal status and shows unexpected collateral lymphatic pathways in 40% of cases. Such information is of the utmost importance in LLLE management and its acquisition is consequently recommended in these patients. SCOPUS: ar.j info:eu-repo/semantics/published |
| Databáze: | OpenAIRE |
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