ANALYSIS OF LYMPHATIC DRAINAGE IN VARIOUS FORMS OF LEG EDEMA USING TWO COMPARTMENT LYMPHOSCINTIGRAPHY

Abstract

The anatomical and functional status of the epifascial and subfascial lymphaticcompartments was analyzed using two compartment lymphoscintigraphy in five groups ofpatients (total 55) with various forms of edema of the lower extremities. Digital whole bodyscintigraphy enabled semiquantitative estimation of radiotracer transport with comparison oflymphatic drainage between those individuals without (normal) and those with leg edema bycalculating the uptake of the radiopharmaceutical transported to regional lymph nodes. A visualassessment of the lymphatic drainage pathways of the legs was also performed.In patients with cyclic idiopathic edema, an accelerated rate of lymphatic transport wasdetected (high lymph volume overload or dynamic insufficiency). In those with venous(phlebo)edemas, high volume lymphatic overload (dynamic insufficiency) of the epifascialcompartment was scintigraphically detected by increased tracer uptake in regional nodes. Inpatients with deep femoral venous occlusion (post-thrombotic syndrome), subfascial lymphatictransport was uniformly markedly reduced (safety valve lymphatic insufficiency). On the otherhand, in the epifascial compartment, lymph transport was accelerated. In those patients withrecurrent or extensive skin ulceration, lymph transport was reduced. Patients with lipedema(obesity) scintigraphically showed no alteration in lymphatic transport.This study demonstrates that lymphatic drainage is notably affected (except in obesitytermed lipedema) in various edemas of the leg. Lymphatic drainage varied depending on thespecific compartment and the pathophysiologic mechanism accounting for the edema. Twocompartment lymphoscintigraphy is a valuable diagnostic tool for accurate assessment of legedema of known and unknown origin.