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First published online May 25, 2006
British Journal of Radiology (2007) 80, 219-226
© 2007 British Institute of Radiology
doi: 10.1259/bjr/68256780
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Pearls and pitfalls of radionuclide imaging of the lymphatic system. Part 2: evaluation of extremity lymphoedema

A F Scarsbrook, BMBS, BMedSci, FRCR A Ganeshan, MRCP and K M Bradley, MRCP, FRCR

Department of Radiology, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK


Figure 1
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  		Figure 1. Normal lower extremity lymphoscintigraphy. Frontal images showing normal(a) calf, (b) popliteal and (c) thigh lymphatic vessels and (d) inguinal nodal uptake.

 

Figure 2
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  		Figure 2. Normal variants.(a) Frontal image showing left sided popliteal nodal uptake (arrow). (b) Frontal image showing normal iliac and para-aortic nodal and hepatic tracer uptake.

 

Figure 3
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  		Figure 3. Primary lymphoedema– absent lymphatic vessels. Frontal image from a lymphoscintigram (thigh level) showing normal right and absent left sided lymphatic vessels in a patient with left sided primary lymphoedema.

 

Figure 4
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  		Figure 4. Primary lymphoedema– paucity of lymphatic vessels. Frontal image showing absent right and attenuated left calf lymphatics with dermal backflow in the right foot and left upper calf (arrows).

 

Figure 5
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  		Figure 5. Primary lymphoedema– absent regional lymph nodes. Frontal image showing normal right sided inguinal and iliac nodal uptake and virtually no uptake in the left groin in a patient with primary left leg lymphoedema.

 

Figure 6
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  		Figure 6. Primary lymphoedema– early dermal backflow. Frontal image taken 20 min post injection showing discontinuity of the right thigh lymphatics and pronounced adjacent dermal backflow in a patient with primary right leg lymphoedema.

 

Figure 7
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  		Figure 7. Secondary lymphoedema– lymphangectasia. (a) Frontal image showing dilated right thigh lymphatics in a patient with right leg oedema due to right sided pelvic lymphatic obstruction by a large ovarian tumour (not shown). (b) Frontal images showing bilateral calf megalymphatics and (c) partial right thigh lymphangectasia in a patient with bilateral lymphoedema. Note also the dermal backflow around the left knee and collateral vessels in the mid left thigh (arrows). The aetiology was felt to be due to chronic bilateral lower limb cellulitis.

 

Figure 8
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  		Figure 8. Secondary lymphoedema– collateral vessels. Frontal image showing prominent right calf collateral vessels in a patient with right leg lymphoedema.

 

Figure 9
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  		Figure 9. Secondary lymphoedema– disruption of lymphatic vessels. Frontal images from two separate patients showing tracer extravasation into the right calf and lymphatic disruption (a, b). Both patients had developed lymphoedema following varicose vein surgery.

 

Figure 10
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  		Figure 10. Secondary lymphoedema– late dermal backflow. Frontal image obtained 3 h after injection showing prominent left sided dermal backflow in the left thigh of a patient with lymphatic obstruction of uncertain aetiology.

 

Figure 11
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  		Figure 11. Importance of patient mobilization.(a) Frontal image showing bilateral complete absence of lower extremity lymphatic tracer uptake on early image (30 min). (b) Later frontal image showing normal bilateral inguinal nodal uptake, immediately following 15 min of walking in the same patient.

 

Figure 12
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  		Figure 12. Importance of delayed imaging. Frontal image obtained 3 h following injection showing extravasation of tracer within the left calf and associated dermal backflow. This was not present on early imaging and was due to lymphatic damage during varicose vein surgery.

 




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