WHOLE-BODY LYMPHANGIOSCINTIGRAPHY AND SPECT/CT IN CHILDREN WITH LYMPHATIC COMPLICATIONS AFTER SURGERY FOR COMPLEX CONGENITAL HEART DISEASE

Abstract

The number of patients surviving repair of
complex congenital heart disease (CCHD) has
increased due to improved surgical techniques,
post operative management and outpatient
care. Likewise, this growing patient population
has demonstrated an increasing number and
complexity of complications involving the lymphatic
system. To evaluate the peripheral and
central lymphatic system, whole-body lymphangioscintigraphy
(LAS) is considered as the
initial imaging evaluation of choice. To date,
very few publications exist on the value of lymphatic
imaging techniques in infants and small
children with lymphatic complications following
surgery for congenital heart disease. A retrospective
review of medical records from 2008
to 2018 was performed for pediatric patients
referred for lymphatic complications after
CCHD surgery at an academic medical center.
LAS and SPECT/CT was performed using intradermal
bipedal injections of Tc 99m labeled
filtered sulfur colloid, and in some patients also
bilateral hand injections, followed by dynamic
imaging and whole- body planar imaging typically
up to 180 minutes post injection. Clinical
decision making and outcomes were recorded.
LAS and SPECT/CT were performed without
complication in pediatric patients with prior
surgery for CCHD. LAS successfully localized
various lymphatic abnormalities such as
lymphatic obstruction, reflux, and leaks, which
were further delineated by SPECT/CT. LAS
findings directed further evaluation with more
definitive studies, management and prognosis.
Five of the ten patients had follow up outcome
data – 2 years and up to 10 years. LAS and
SPECT/CT are safe and effective techniques
for the initial evaluation of lymphatic abnormalities
in pediatric patients with CCHD.
LAS, particularly with further 3D localization
by SPECT/CT, provides functional imaging
of peripheral and central lymphatic flow and
thus provides guidance for medical therapy,
non operative interventional management, and
surgical therapy for these diverse, debilitating,
and often life threatening disorders.