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