Lymphedema by Arin K. Greene Sumner A. Slavin & Håkan Brorson

Author:Arin K. Greene, Sumner A. Slavin & Håkan Brorson
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Additional Injections

In our clinical experience, one third of the patients (with upper and/or lower limb lymphedema) show none of the lymph nodes expected to be seen at the root of the limb, either in the axillary area or in the inguinal and/or iliac area. This outcome raised two possibilities: either the tracer injected peripherally was not transported up and into these lymph nodes, which are in fact present, or these lymph nodes are absent as either a normal variant, or a symptom of a lymphatic disease. This question can be addressed by the use of an additional injection.

In three fourths of upper limb lymphedemas, intradermal injection of 99mTc-labeled Human Serum Albumin (HSA) nanocolloids (twice what is injected into the hands) in the lateral part of the arm under the shoulder led either spontaneously or after massage to the lymphatic drainage of the tracer towards the homolateral axillary lymph nodes. In some cases, collateralization lymphatic pathways reaching lymph nodes in the ipsilateral supra and/or retro-clavicular area were also demonstrated (the Caplan’s and Mascagni’s pathways), as were the ipsilateral posterior scapular and/or cervical lymph nodes, the ipsilateral internal mammary, and the contralateral parasternal and/or axillary lymph nodes (see Fig. 15.3).

Fig. 15.3From left to right and from top to bottom, anterior views centered on the axilla in a woman with post-therapeutic left upper limb lymphedema where the subcutaneous injection of 99mTc-HSA nanocolloid in the first interdigital space of the hands showed normal right axillary nodes, but no node in the left axilla. Intradermal injection was then performed at the level of the upper and external part of the left arm (vertical arrow) and the tracer was shown to spontaneously flow toward the retroclavicular lymph nodes (left to right oblique arrows) and also toward the left anterior chest wall, to cross the midline to reach the opposite axillary lymph nodes (right to left oblique arrows). With permission from Bourgeois P. Combined Role of Lymphoscintigraphy, X-ray Computed Tomography, Magnetic Resonance Imaging, and Positron Emission Tomography in the Management of Lymphedematous Disease. In: Lee BB, Bergan J, Rockson SG, eds. Lymphedema: A concise compendium of theory and practice © Springer 2011

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.