Lymphoscintigraphy in Unilateral Lower Limb and Scrotal Lymphedema Caused by Filariasis
Identifieur interne : 002091 ( Pmc/Corpus ); précédent : 002090; suivant : 002092Lymphoscintigraphy in Unilateral Lower Limb and Scrotal Lymphedema Caused by Filariasis
Auteurs : Padma Subramanyam ; Shanmuga Sundaram PalaniswamySource :
- The American Journal of Tropical Medicine and Hygiene [ 0002-9637 ] ; 2012.
Abstract
Lymphedema is the edema that results from chronic lymphatic insufficiency. Lymphatic filariasis is caused by the filarial nematodes
Url:
DOI: 10.4269/ajtmh.2012.12-0422
PubMed: 23222136
PubMed Central: 3516097
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Lymphoscintigraphy in Unilateral Lower Limb and Scrotal Lymphedema Caused by Filariasis</title><author><name sortKey="Subramanyam, Padma" sort="Subramanyam, Padma" uniqKey="Subramanyam P" first="Padma" last="Subramanyam">Padma Subramanyam</name></author><author><name sortKey="Palaniswamy, Shanmuga Sundaram" sort="Palaniswamy, Shanmuga Sundaram" uniqKey="Palaniswamy S" first="Shanmuga Sundaram" last="Palaniswamy">Shanmuga Sundaram Palaniswamy</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23222136</idno><idno type="pmc">3516097</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3516097</idno><idno type="RBID">PMC:3516097</idno><idno type="doi">10.4269/ajtmh.2012.12-0422</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">002091</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002091</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Lymphoscintigraphy in Unilateral Lower Limb and Scrotal Lymphedema Caused by Filariasis</title><author><name sortKey="Subramanyam, Padma" sort="Subramanyam, Padma" uniqKey="Subramanyam P" first="Padma" last="Subramanyam">Padma Subramanyam</name></author><author><name sortKey="Palaniswamy, Shanmuga Sundaram" sort="Palaniswamy, Shanmuga Sundaram" uniqKey="Palaniswamy S" first="Shanmuga Sundaram" last="Palaniswamy">Shanmuga Sundaram Palaniswamy</name></author></analytic><series><title level="j">The American Journal of Tropical Medicine and Hygiene</title><idno type="ISSN">0002-9637</idno><idno type="eISSN">1476-1645</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Lymphedema is the edema that results from chronic lymphatic insufficiency. Lymphatic filariasis is caused by the filarial nematodes <italic>Wuchereria bancrofti</italic>, <italic>Brugia malayi</italic>, and <italic>Brugia timori</italic>. Lymphatic filariasis is common in tropical and subtropical regions. Early diagnosis and prompt therapy can be implemented using lymphoscintigraphy. Our patient is a 15-year-old boy presenting with a 3-month history of hydrocele. The patient was referred to us to rule out any lower limb lymphatic obstruction as the patient is from an endemic area. Tc Sulfur colloid (filtered) lymphoscintigraphy showed abnormal tracer collection in the scrotum and penis. There is associated dermal backflow or stasis in the left thigh region extending just above the knee, suggesting partial obstruction of left inguinal lymphatic channels.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Freedman, Do" uniqKey="Freedman D">DO Freedman</name></author><author><name sortKey="Almeida Filho, Pj" uniqKey="Almeida Filho P">PJ Almeida Filho</name></author><author><name sortKey="Besh, S" uniqKey="Besh S">S Besh</name></author><author><name sortKey="Maia E Silve, Mc" uniqKey="Maia E Silve M">MC Maia e Silve</name></author><author><name sortKey="Braga, C" uniqKey="Braga C">C Braga</name></author><author><name sortKey="Maciel, A" uniqKey="Maciel A">A Maciel</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Am J Trop Med Hyg</journal-id><journal-id journal-id-type="iso-abbrev">Am. J. Trop. Med. Hyg</journal-id><journal-id journal-id-type="publisher-id">tpmd</journal-id><journal-title-group><journal-title>The American Journal of Tropical Medicine and Hygiene</journal-title></journal-title-group><issn pub-type="ppub">0002-9637</issn><issn pub-type="epub">1476-1645</issn><publisher><publisher-name>The American Society of Tropical Medicine and Hygiene</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23222136</article-id><article-id pub-id-type="pmc">3516097</article-id><article-id pub-id-type="doi">10.4269/ajtmh.2012.12-0422</article-id><article-categories><subj-group subj-group-type="heading"><subject>Images in Clinical Tropical Medicine</subject></subj-group></article-categories><title-group><article-title>Lymphoscintigraphy in Unilateral Lower Limb and Scrotal Lymphedema Caused by Filariasis</article-title><alt-title alt-title-type="left-running-head">SUBRAMANYAM AND PALANISWAMY</alt-title><alt-title alt-title-type="right-running-head">LYMPHOSCINTIGRAPHY IN LYMPHEDEMA CAUSED BY FILARIASIS</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Subramanyam</surname><given-names>Padma</given-names></name><xref ref-type="corresp" rid="COR1">*</xref></contrib><contrib contrib-type="author"><name><surname>Palaniswamy</surname><given-names>Shanmuga Sundaram</given-names></name></contrib></contrib-group><aff id="AFF1">Department of Nuclear Medicine and PETCT, Amrita Institute of Medical Sciences, Cochin, Kerala, India</aff><author-notes><corresp id="COR1">*Address correspondence to Padma Subramanyam, Department of Nuclear Medicine and PETCT, Amrita Institute of Medical Sciences, Cochin-6802041, Kerala, India. E-mail: <email>padmas@aims.amrita.edu</email></corresp></author-notes><pub-date pub-type="ppub"><day>05</day><month>12</month><year>2012</year></pub-date><pub-date pub-type="pmc-release"><day>05</day><month>12</month><year>2012</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on the
<volume>87</volume><issue>6</issue><fpage>963</fpage><lpage>964</lpage><history><date date-type="received"><day>10</day><month>7</month><year>2012</year></date><date date-type="accepted"><day>20</day><month>7</month><year>2012</year></date></history><permissions><copyright-statement>©The American Society of Tropical Medicine and Hygiene</copyright-statement><copyright-year>2012</copyright-year><license license-type="open-access"><license-p>This is an Open Access article distributed under the terms of the American Society of Tropical Medicine and Hygiene's Re-use License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Lymphedema is the edema that results from chronic lymphatic insufficiency. Lymphatic filariasis is caused by the filarial nematodes <italic>Wuchereria bancrofti</italic>, <italic>Brugia malayi</italic>, and <italic>Brugia timori</italic>. Lymphatic filariasis is common in tropical and subtropical regions. Early diagnosis and prompt therapy can be implemented using lymphoscintigraphy. Our patient is a 15-year-old boy presenting with a 3-month history of hydrocele. The patient was referred to us to rule out any lower limb lymphatic obstruction as the patient is from an endemic area. Tc Sulfur colloid (filtered) lymphoscintigraphy showed abnormal tracer collection in the scrotum and penis. There is associated dermal backflow or stasis in the left thigh region extending just above the knee, suggesting partial obstruction of left inguinal lymphatic channels.</p></abstract></article-meta></front><body><p>Lymphatic filariasis is common in tropical and subtropical regions.<xref ref-type="bibr" rid="R1">1</xref> A 15-year-old boy presented with 3 months of scrotal edema. Although residence in a tropical area raises a high suspicion for lymphatic filariasis caused by <italic>Wuchereria bancrofti</italic>, which can usually be diagnosed with an antigen detection card test, this patient was evaluated for lymphatic obstruction. Imaging was performed with one millicurie (mCi) of filtered Technetium sulfur colloid (<xref ref-type="fig" rid="F1">Figure 1</xref><fig id="F1" position="float"><label>Figure 1.</label><caption><p>Bilateral lower limb lymphoscintigraphy with filtered Tc Sulfur colloid. The initial images of both lower limbs show good progression of colloid particles through bilateral lower limb lymphatic channels. There is normal visualization of the bilateral inguinal group of lymph nodes in initial images. However, there are fewer left inguinal lymph nodes. Liver is visualized normally. Delayed image showed abnormal tracer collection in the scrotum and penis (depicted with annotation “Sc”). There is dermal backflow or stasis in the left thigh region (marked as DB in anterior and posterior views) extending up to the knee. Thus, lymphoscintigraphy was suggestive of early partial obstruction of the left inguinal lymphatics.</p></caption><graphic xlink:href="tropmed-87-963-g001"></graphic></fig>). Four intradermal injections were given in the first and second webspaces of each foot in equal divided doses. After a brisk walk, whole body anterior and posterior images were acquired immediately and 2 hours later using a dual head variable angle Gamma camera. Images showed abnormal tracer collection in the scrotum and penis with associated unsuspected dermal backflow/stasis in the left thigh region extending just above the knee. Lymphoscintigraphy was consistent with early partial obstruction of left inguinal lymphatics. A computed tomographic scan of the abdomen (<xref ref-type="fig" rid="F2">Figure 2</xref><fig id="F2" position="float"><label>Figure 2.</label><caption><p>(<bold>A</bold>) Transaxial (<bold>B</bold>) coronal sections of CT abdomen shows soft tissue stranding (marked as STS) in the lower anterior abdominal wall and left inguinal region suggestive of inflammatory changes (cellulitis), better seen in coronal view. A few enlarged lymph nodes were also noted along the left common femoral artery and in the bilateral inguinal region of average measurement 8 × 1 cm in its short axis. Bilateral scrotal oedema noted (marked as SE).</p></caption><graphic xlink:href="tropmed-87-963-g002"></graphic></fig>) showed soft tissue stranding in the lower anterior abdominal wall and left inguinal region suggestive of inflammatory changes (cellulitis) with bilateral scrotal edema. Microscopic examination of the surgically removed left spermatic cord showed a filarial nematode (<italic>W. bancrofti</italic>) (<xref ref-type="fig" rid="F3">Figure 3</xref>). Although both <italic>W. bancrofti</italic> and <italic>Brugia malayi</italic> exist in Kerala, <italic>B. malayi</italic> rarely produces scrotal involvement or swelling above the knee. Lymphatic filariasis may be acute or chronic by presentation. Acute lymphangitis, often recurrent, is characterized by fever, chills, and erythema. Adult worms (macrofilariae) are usually concentrated in the inguinal and scrotal lymphatics, and thus lower limb and inguinal symptoms are more common, although the upper limbs and breasts may also be affected rarely. Chronicity may manifest as limb lymphedema, hydroceles, and chyluria.</p><fig id="F3" position="float"><label>Figure 3.</label><caption><p>Showing the cross-sectional view of a filarial nematode in the left spermatic cord, with surrounding intense eosinophilic inflammatory infiltrate (magnification, ×400). U = denotes uterine tubes, M = the musculature, I = the intestinal loop and C is the cuticle.</p></caption><graphic xlink:href="tropmed-87-963-g003"></graphic></fig></body><back><fn-group><fn id="FN1" fn-type="present-address"><p>Authors' addresses: Padma Subramanyam and Shanmuga Sundaram Palaniswamy, Department of Nuclear Medicine and PETCT, Amrita Institute of Medical Sciences, Cochin, Kerala, India, E-mails: <email>padmas@aims.amrita.edu</email> and <email>ssundaram@aims.amrita.edu</email>.</p></fn></fn-group><ref-list><ref id="R1"><label>1.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Freedman</surname><given-names>DO</given-names></name><name><surname>Almeida Filho</surname><given-names>PJ</given-names></name><name><surname>Besh</surname><given-names>S</given-names></name><name><surname>Maia e Silve</surname><given-names>MC</given-names></name><name><surname>Braga</surname><given-names>C</given-names></name><name><surname>Maciel</surname><given-names>A</given-names></name></person-group><year>1994</year><article-title>Lymphoscitnigraphic analysis of lymphatic abnormalities in symptomatic and asymptomatic human filariasis</article-title><source>J Infect Dis</source><volume>170</volume><fpage>927</fpage><lpage>933</lpage><pub-id pub-id-type="pmid">7523538</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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