Role of lymphoscintigraphy in diagnosis and management of patients with leg swelling of unclear etiology
Identifieur interne : 005D21 ( Ncbi/Merge ); précédent : 005D20; suivant : 005D22Role of lymphoscintigraphy in diagnosis and management of patients with leg swelling of unclear etiology
Auteurs : Tek Chand Kalawat [Inde] ; Ravi Kumar Chittoria [Inde] ; Praveen Kumar Reddy [Inde] ; Batchu Suneetha [Inde] ; Ravishwar Narayan [Inde] ; Parthsarthi Ravi [Inde]Source :
- Indian Journal of Nuclear Medicine : IJNM : The Official Journal of the Society of Nuclear Medicine, India [ 0972-3919 ] ; 2012.
Abstract
To study the utility of lymphoscintigraphy in detection of lymphatic obstruction in patients with leg swelling of unclear etiology, selection of site for nodo venous shunt procedure, and follow-up lymphoscintigraphic documentation of improved lymph flow in surgically treated limb.
Twenty four consecutive patients with leg swelling, 10 male, 14 female with mean age 47 years, range from 13 years to 74 years underwent lymphoscintigraphy. All patients were referred from Department of Plastic Surgery, after initial work-up, and routine investigations to rule out the other causes of leg swelling. Both clinical and scintigraphic staging performed for all patients. All clinically and scintigraphically positive patients treated with decongestive lymphatic therapy (DLT). In addition to the DLT, those patients positive for unilateral or bilateral lymphedema, consented for surgical intervention, nodo venous shunt (NVS) in their only affected or one of the two affected lower limbs. Follow-up lymphoscintigraphy performed in operated cases after 3 months to 6 months of surgery, lymphoscintigraphy images of each patient in pre and post-surgery compared.
In 20/24 cases (83%) of clinically positive leg swelling were found to be positive for lymphedema on lymphoscintigraphy and remaining, 4/24 were scintigraphically normal. Based on the clinical and lymphoscintigraphy staging, 03/20 cases (15%) had Grade I lymphedema, 01/20 (5%) Grade II lymphedema, 06/20 (30%) Grade III and remaining 10/20 (50%) had Grade IV lymphedema. 11/20 cases of Lymphedema (55%) were managed conservatively by only DLT and in remaining 09/20 cases (45%), who were case of Grade IV, lymphedema (five patients with unilateral and four patients with bilateral disease) initially treated with DLT, and on completion of DLT, undergone for NVS procedure, in their unilaterally affected lower limb or one of the two diseased lower limbs. All nine patients showed remarkable clinical improvement in leg swelling and their follow-up lymphoscintigraphy showed normal visualization of lymphatic channels. No patient developed any recurrence.
Pre-operative functional evaluation of lymphatic channels using lymphoscintigraphy, is a widely available, simple imaging test and highly useful for documentation of lymphedema in patients with leg swelling of unclear etiology and also for exact localization of inguinal lymph nodes to perform the NVS procedure. Further, it can play important role for follow-up of patients receiving DLT or DLT with surgical intervention that provides early relief from clinical symptoms.
Url:
DOI: 10.4103/0972-3919.115392
PubMed: 24019651
PubMed Central: 3759082
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<front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background:</title>
<p>To study the utility of lymphoscintigraphy in detection of lymphatic obstruction in patients with leg swelling of unclear etiology, selection of site for nodo venous shunt procedure, and follow-up lymphoscintigraphic documentation of improved lymph flow in surgically treated limb.</p>
</sec>
<sec id="st2"><title>Materials and Methods:</title>
<p>Twenty four consecutive patients with leg swelling, 10 male, 14 female with mean age 47 years, range from 13 years to 74 years underwent lymphoscintigraphy. All patients were referred from Department of Plastic Surgery, after initial work-up, and routine investigations to rule out the other causes of leg swelling. Both clinical and scintigraphic staging performed for all patients. All clinically and scintigraphically positive patients treated with decongestive lymphatic therapy (DLT). In addition to the DLT, those patients positive for unilateral or bilateral lymphedema, consented for surgical intervention, nodo venous shunt (NVS) in their only affected or one of the two affected lower limbs. Follow-up lymphoscintigraphy performed in operated cases after 3 months to 6 months of surgery, lymphoscintigraphy images of each patient in pre and post-surgery compared.</p>
</sec>
<sec id="st3"><title>Results:</title>
<p>In 20/24 cases (83%) of clinically positive leg swelling were found to be positive for lymphedema on lymphoscintigraphy and remaining, 4/24 were scintigraphically normal. Based on the clinical and lymphoscintigraphy staging, 03/20 cases (15%) had Grade I lymphedema, 01/20 (5%) Grade II lymphedema, 06/20 (30%) Grade III and remaining 10/20 (50%) had Grade IV lymphedema. 11/20 cases of Lymphedema (55%) were managed conservatively by only DLT and in remaining 09/20 cases (45%), who were case of Grade IV, lymphedema (five patients with unilateral and four patients with bilateral disease) initially treated with DLT, and on completion of DLT, undergone for NVS procedure, in their unilaterally affected lower limb or one of the two diseased lower limbs. All nine patients showed remarkable clinical improvement in leg swelling and their follow-up lymphoscintigraphy showed normal visualization of lymphatic channels. No patient developed any recurrence.</p>
</sec>
<sec id="st4"><title>Conclusion:</title>
<p>Pre-operative functional evaluation of lymphatic channels using lymphoscintigraphy, is a widely available, simple imaging test and highly useful for documentation of lymphedema in patients with leg swelling of unclear etiology and also for exact localization of inguinal lymph nodes to perform the NVS procedure. Further, it can play important role for follow-up of patients receiving DLT or DLT with surgical intervention that provides early relief from clinical symptoms.</p>
</sec>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Role of lymphoscintigraphy in diagnosis and management of patients with leg swelling of unclear etiology</title>
<author><name sortKey="Kalawat, Tek Chand" sort="Kalawat, Tek Chand" uniqKey="Kalawat T" first="Tek Chand" last="Kalawat">Tek Chand Kalawat</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India</nlm:aff>
<country xml:lang="fr">Inde</country>
<wicri:regionArea>Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh</wicri:regionArea>
<wicri:noRegion>Andhra Pradesh</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Chittoria, Ravi Kumar" sort="Chittoria, Ravi Kumar" uniqKey="Chittoria R" first="Ravi Kumar" last="Chittoria">Ravi Kumar Chittoria</name>
<affiliation wicri:level="1"><nlm:aff id="aff2">Department of Plastic Surgery, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India</nlm:aff>
<country xml:lang="fr">Inde</country>
<wicri:regionArea>Department of Plastic Surgery, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh</wicri:regionArea>
<wicri:noRegion>Andhra Pradesh</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Reddy, Praveen Kumar" sort="Reddy, Praveen Kumar" uniqKey="Reddy P" first="Praveen Kumar" last="Reddy">Praveen Kumar Reddy</name>
<affiliation wicri:level="1"><nlm:aff id="aff2">Department of Plastic Surgery, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India</nlm:aff>
<country xml:lang="fr">Inde</country>
<wicri:regionArea>Department of Plastic Surgery, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh</wicri:regionArea>
<wicri:noRegion>Andhra Pradesh</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Suneetha, Batchu" sort="Suneetha, Batchu" uniqKey="Suneetha B" first="Batchu" last="Suneetha">Batchu Suneetha</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India</nlm:aff>
<country xml:lang="fr">Inde</country>
<wicri:regionArea>Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh</wicri:regionArea>
<wicri:noRegion>Andhra Pradesh</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Narayan, Ravishwar" sort="Narayan, Ravishwar" uniqKey="Narayan R" first="Ravishwar" last="Narayan">Ravishwar Narayan</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India</nlm:aff>
<country xml:lang="fr">Inde</country>
<wicri:regionArea>Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh</wicri:regionArea>
<wicri:noRegion>Andhra Pradesh</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Ravi, Parthsarthi" sort="Ravi, Parthsarthi" uniqKey="Ravi P" first="Parthsarthi" last="Ravi">Parthsarthi Ravi</name>
<affiliation wicri:level="1"><nlm:aff id="aff1">Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India</nlm:aff>
<country xml:lang="fr">Inde</country>
<wicri:regionArea>Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh</wicri:regionArea>
<wicri:noRegion>Andhra Pradesh</wicri:noRegion>
</affiliation>
</author>
</analytic>
<series><title level="j">Indian Journal of Nuclear Medicine : IJNM : The Official Journal of the Society of Nuclear Medicine, India</title>
<idno type="ISSN">0972-3919</idno>
<idno type="eISSN">0974-0244</idno>
<imprint><date when="2012">2012</date>
</imprint>
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<front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background:</title>
<p>To study the utility of lymphoscintigraphy in detection of lymphatic obstruction in patients with leg swelling of unclear etiology, selection of site for nodo venous shunt procedure, and follow-up lymphoscintigraphic documentation of improved lymph flow in surgically treated limb.</p>
</sec>
<sec id="st2"><title>Materials and Methods:</title>
<p>Twenty four consecutive patients with leg swelling, 10 male, 14 female with mean age 47 years, range from 13 years to 74 years underwent lymphoscintigraphy. All patients were referred from Department of Plastic Surgery, after initial work-up, and routine investigations to rule out the other causes of leg swelling. Both clinical and scintigraphic staging performed for all patients. All clinically and scintigraphically positive patients treated with decongestive lymphatic therapy (DLT). In addition to the DLT, those patients positive for unilateral or bilateral lymphedema, consented for surgical intervention, nodo venous shunt (NVS) in their only affected or one of the two affected lower limbs. Follow-up lymphoscintigraphy performed in operated cases after 3 months to 6 months of surgery, lymphoscintigraphy images of each patient in pre and post-surgery compared.</p>
</sec>
<sec id="st3"><title>Results:</title>
<p>In 20/24 cases (83%) of clinically positive leg swelling were found to be positive for lymphedema on lymphoscintigraphy and remaining, 4/24 were scintigraphically normal. Based on the clinical and lymphoscintigraphy staging, 03/20 cases (15%) had Grade I lymphedema, 01/20 (5%) Grade II lymphedema, 06/20 (30%) Grade III and remaining 10/20 (50%) had Grade IV lymphedema. 11/20 cases of Lymphedema (55%) were managed conservatively by only DLT and in remaining 09/20 cases (45%), who were case of Grade IV, lymphedema (five patients with unilateral and four patients with bilateral disease) initially treated with DLT, and on completion of DLT, undergone for NVS procedure, in their unilaterally affected lower limb or one of the two diseased lower limbs. All nine patients showed remarkable clinical improvement in leg swelling and their follow-up lymphoscintigraphy showed normal visualization of lymphatic channels. No patient developed any recurrence.</p>
</sec>
<sec id="st4"><title>Conclusion:</title>
<p>Pre-operative functional evaluation of lymphatic channels using lymphoscintigraphy, is a widely available, simple imaging test and highly useful for documentation of lymphedema in patients with leg swelling of unclear etiology and also for exact localization of inguinal lymph nodes to perform the NVS procedure. Further, it can play important role for follow-up of patients receiving DLT or DLT with surgical intervention that provides early relief from clinical symptoms.</p>
</sec>
</div>
</front>
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<pubmed><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Role of lymphoscintigraphy in diagnosis and management of patients with leg swelling of unclear etiology.</title>
<author><name sortKey="Kalawat, Tek Chand" sort="Kalawat, Tek Chand" uniqKey="Kalawat T" first="Tek Chand" last="Kalawat">Tek Chand Kalawat</name>
<affiliation wicri:level="1"><nlm:affiliation>Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India.</nlm:affiliation>
<country xml:lang="fr">Inde</country>
<wicri:regionArea>Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh</wicri:regionArea>
<wicri:noRegion>Andhra Pradesh</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Chittoria, Ravi Kumar" sort="Chittoria, Ravi Kumar" uniqKey="Chittoria R" first="Ravi Kumar" last="Chittoria">Ravi Kumar Chittoria</name>
</author>
<author><name sortKey="Reddy, Praveen Kumar" sort="Reddy, Praveen Kumar" uniqKey="Reddy P" first="Praveen Kumar" last="Reddy">Praveen Kumar Reddy</name>
</author>
<author><name sortKey="Suneetha, Batchu" sort="Suneetha, Batchu" uniqKey="Suneetha B" first="Batchu" last="Suneetha">Batchu Suneetha</name>
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<author><name sortKey="Narayan, Ravishwar" sort="Narayan, Ravishwar" uniqKey="Narayan R" first="Ravishwar" last="Narayan">Ravishwar Narayan</name>
</author>
<author><name sortKey="Ravi, Parthsarthi" sort="Ravi, Parthsarthi" uniqKey="Ravi P" first="Parthsarthi" last="Ravi">Parthsarthi Ravi</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en">Role of lymphoscintigraphy in diagnosis and management of patients with leg swelling of unclear etiology.</title>
<author><name sortKey="Kalawat, Tek Chand" sort="Kalawat, Tek Chand" uniqKey="Kalawat T" first="Tek Chand" last="Kalawat">Tek Chand Kalawat</name>
<affiliation wicri:level="1"><nlm:affiliation>Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India.</nlm:affiliation>
<country xml:lang="fr">Inde</country>
<wicri:regionArea>Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh</wicri:regionArea>
<wicri:noRegion>Andhra Pradesh</wicri:noRegion>
</affiliation>
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<author><name sortKey="Chittoria, Ravi Kumar" sort="Chittoria, Ravi Kumar" uniqKey="Chittoria R" first="Ravi Kumar" last="Chittoria">Ravi Kumar Chittoria</name>
</author>
<author><name sortKey="Reddy, Praveen Kumar" sort="Reddy, Praveen Kumar" uniqKey="Reddy P" first="Praveen Kumar" last="Reddy">Praveen Kumar Reddy</name>
</author>
<author><name sortKey="Suneetha, Batchu" sort="Suneetha, Batchu" uniqKey="Suneetha B" first="Batchu" last="Suneetha">Batchu Suneetha</name>
</author>
<author><name sortKey="Narayan, Ravishwar" sort="Narayan, Ravishwar" uniqKey="Narayan R" first="Ravishwar" last="Narayan">Ravishwar Narayan</name>
</author>
<author><name sortKey="Ravi, Parthsarthi" sort="Ravi, Parthsarthi" uniqKey="Ravi P" first="Parthsarthi" last="Ravi">Parthsarthi Ravi</name>
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<series><title level="j">Indian journal of nuclear medicine : IJNM : the official journal of the Society of Nuclear Medicine, India</title>
<idno type="ISSN">0972-3919</idno>
<imprint><date when="2012" type="published">2012</date>
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<front><div type="abstract" xml:lang="en">To study the utility of lymphoscintigraphy in detection of lymphatic obstruction in patients with leg swelling of unclear etiology, selection of site for nodo venous shunt procedure, and follow-up lymphoscintigraphic documentation of improved lymph flow in surgically treated limb.</div>
</front>
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