J Korean Soc Radiol.  2018 Jan;78(1):73-76. 10.3348/jksr.2018.78.1.73.

Acute Traumatic Lymphedema without Tissue Injury Detected by Lymphoscintigraphy

• Kang SM
• Lee SM
• Kim SY

• KMID: 2399309
• DOI: http://doi.org/10.3348/jksr.2018.78.1.73

Abstract

Lymphedema is an important disease that causes regional swelling. Although it is not life threatening, it significantly affects the physical and psychological status of the patient. Additionally, lymphedema treatment may be difficult, when its diagnosis is delayed. However, it is not possible to conclude a diagnosis of lymphedema, when the clinical history is uncertain. As observed in the current case, lymphedema caused by minor trauma without any fracture or internal wounds, was detected using a lymphoscintigraphy. Hence, even minor trauma can cause lymphedema and a lymphoscintigraphy can provide critical information for the diagnosis of lymphedema. For this reason, a lymphoscintigraphy test is considered in situations where patients there is differential diagnosis of lymphedema.

MeSH Terms

Diagnosis
Diagnosis, Differential
Humans
Lymphedema*
Lymphoscintigraphy*
Wounds and Injuries

Figure

• 

  Fig. 1 Lymphoscintigraphy with 1-hour (A) and 2-hour (B) images showing delayed lymphatic flow and dermal backflow with collateral lymphatics in the right lower limb. It also reveals non-visualization of the right inguinal lymph node, suggesting lymphatic obstruction below the inguinal lymph node level.

Reference

1. Rockson SG. Lymphedema. Am J Med. 2001; 110:288–295.

2. Jensen MR, Simonsen L, Karlsmark T, Bülow J. Lymphoedema of the lower extremities--background, pathophysiology and diagnostic considerations. Clin Physiol Funct Imaging. 2010; 30:389–398.

3. Rockson SG, Rivera KK. Estimating the population burden of lymphedema. Ann N Y Acad Sci. 2008; 1131:147–154.

4. Balakrishnan C, Bradt LM, Khalil AJ, Trupiano JM. Lymphedema of the upper extremity following circumferential burns. Can J Plast Surg. 2004; 12:79–80.

5. Anand S, Lal H, Dhaon BK. Lymphedema of the lower extremity as a complication of local burns. Burns. 1998; 24:767–769.

6. Cohen MD. Complete decongestive physical therapy in a patient with secondary lymphedema due to orthopedic trauma and surgery of the lower extremity. Phys Ther. 2011; 91:1618–1626.

7. Kasper DA, Meller MM. Lymphedema of the hand and forearm following fracture of the distal radius. Orthopedics. 2008; 31:172.

8. Tiwari A, Cheng KS, Button M, Myint F, Hamilton G. Differential diagnosis, investigation, and current treatment of lower limb lymphedema. Arch Surg. 2003; 138:152–161.

9. Szczesny G, Olszewski WL, Zaleska M. Limb lymph node response to bone fracture. Lymphat Res Biol. 2004; 2:155–164.

10. Yuan Z, Chen L, Luo Q, Zhu J, Lu H, Zhu R. The role of radionuclide lymphoscintigraphy in extremity lymphedema. Ann Nucl Med. 2006; 20:341–344.