Case Series and Scintigraphy Pictorial Review of Bilateral Lower Limb Lymphoedema: Chronic Swollen Legs Aren’t Always due to Venous, Cardiac or Renal Diseases
Author: Nur Faezah Che Mat, Ahmad Zaid Zanial
Lymphoedema is a chronic condition due to lymphatic drainage abnormality causing swollen limbs. Although less-known, scintigraphy evaluation of lymphatic system or lymphoscintigraphy is a relatively simple, low radiation and valuable functional imaging to assess lymphoedema. We present case series of patients with prolong leg swelling demonstrating positive findings for bilateral lower limb lymphoedema as depicted on lymphoscintigraphy to highlight the complementary diagnostic role of this imaging modality, scan findings and patients’ clinical parameters. Review of clinical records of patients referred for lymphoscintigraphy (2014-2020). All patients with bilateral lower limb lymphoedema were included (n=3). They were obese but none had any lower limb trauma or documented deep vein thrombosis or prior filariasis infection. No history of heart or renal failure. Non pitting leg oedema with no signs of acute infection or inflammation noted. They received radioactive Technetium99m-nanocolloid tracer injections at the first and second web-spaces of each foot totalling 2 millicurie prior to dynamic imaging acquisition followed by whole-body scanning as per departmental protocol. Case 1: 61 year-old male presented with bilateral chronic swollen legs (24 months) and underlying liver cirrhosis had demonstrated right leg abnormal delay tracer progression and bilateral dermal backflow on scintigraphy. Case 2: 43 year-old male presented with more prominent right leg swelling (6 months) and history of cellulitis had demonstrated abnormal tracer progression in right leg and dermal backflow with popliteal nodes seen bilaterally on lymphoscintigraphy. Case 3: 46 year-old male presented with bilateral chronic swollen legs (24 months) and history of cellulitis had demonstrated abnormal tracer progression in left leg with contralateral right dermal backflow on scintigraphy. In conclusion, lymphoscintigraphy is a useful tool to evaluate lymphoedema. We discussed cases of chronic swollen legs who had positive scintigraphy findings suggestive of bilateral lymphoedema as well as their clinical presentations and risk factors.
Keywords: Lower limb swelling, lymphoedema, lymphoscintigraphy
- Jabatan Kesihatan WP Kuala Lumpur dan Putrajaya
- Jabatan Perubatan Nuklear, Hospital Kuala Lumpur
Correspondence to: Ahmad Zaid Zanial, Nuclear Medicine Physician, Hospital Kuala Lumpur, Jalan Pahang 50586 WP Kuala Lumpur, Malaysia, [email protected]