investigations of lymphatics
TRANSCRIPT
By Kareem Hamimy6 th year Medical StudentKasr al Ainy Medical School
Usually Clinical is enough If typical, mild, no complicaions,
No Need for investigations If atypical, Multifactorial Swelling
Help to confirm Inform management Provide prognostic information
Full blood count Blood Sugar level Urea and electrolytes Creatinine Liver, thyroid function tests Chest x-ray Urine dipstick (chyluria) Blood smear (microfilaria)
Direct Indirect
Principle ?? (Dye-Inject- Oily- PLV-contrast-Radiographic)
Was Gold Stndard, Now Obsolete (why ?)Surgical exposureDamage to the lymphatic endothelium by oilPulmonary oil embolismWound infection
Used in Few CasesPreoperative MegaLymphatics considered for bypass or
fistula ligation
Principle?? ( Inject- Intradermal- nonionic contrast- Radiographic)
Shows the Distal lyphatics but not normally proximal lymphatics
Gold Standard Now Principle ?? ( Radioactive technitium ptn – colloid
particles- interdigital Webspaces- serial radiograph gamma camera
high-resolution imaging of peripheral lymphatic vessels provides insight into lymph flow dynamics. helps evaluate lymphatic truncal anatomy and
radiotracer transport. It can also be used to evaluate the efficacy of various
treatment options designed to facilitate lymph flow or reduce lymph formation.
The procedure is essentially noninvasive, can easily be repeated, and does not adversely affect the lymphatic vascular endothelium.
Arms
Legs
Axial Computerised tomography To Exclude Tumours Causing Edema Also lymphedema can appear in CT ( As Coarse,
non enhancing, reticular, honey comb pattern in an enlarged subcutaneous compartment)
Magnetic resonance Imaging Clear Images of lymphatic Channels and lymph
nodes Useful in pts with lymphatic hyperplasia Distinguish between Venous and lymphatic shows tumours causing obstructions Expensive
Shows venous abnormality For Filariasis
Where Malignancy is suspected Lymph node biopsy Skin Biopsy where lymphangiosarcoma is
suspected
Right leg lymphedema and groin mass in a 72-year-old man. Clinical photograph shows marked enlargement of the right
leg. Presurgical lymphangioscintigrams obtained 35 minutes
(left) and 4½ hours (right) after injection of radiotracer demonstrate prominent dermal backflow in the right leg with intact trunks superiorly, findings that are suggestive of secondary lymphedema
CT, MRI Showing Cystic mass very near to the Hip Joint Clinical photograph taken 6 weeks after excision of a large
synovial cyst demonstrates resolution of overt edema
Bailey and Love: Short Practice of Surgery http://radiographics.rsna.org/content/20/6/1697.full