Abstract

Research Article

Lymphoscintigraphic Investigations for Women with Lower Limb Edemas After One Pregnancy

Callebaut Gregory, Leduc Olivier and Pierre Bourgeois*

Published: 11 February, 2025 | Volume 9 - Issue 3 | Pages: 066-072

Lower extremity edema is one of the most common complaints among pregnant patients. Lymphatic origin to these edemas is rarely considered and few cases of lymphedema after pregnancy have been reported and documented in medical literature. We describe here a series of 15 cases where the diagnosis of lymphedema was established by lymphoscintigraphy.  Dermal reflux was observed in ten of the 15 patients (66%), popliteal lymph nodes in 11 (73%), and the edematous limb(s) were said to be abnormal in all but one case which showed only functional asymmetry at rest and limited vascular reflux in a calf.

Read Full Article HTML DOI: 10.29328/journal.acr.1001129 Cite this Article Read Full Article PDF

Keywords:

Pregnancy; Lymphedema; Primary; Lymphoscintigraphy

References

  1. Lebech M, Hansen M, Knudsen A. Headache, fatigue and edema of the lower limbs during the third trimester of normal pregnancy. Ugeskr Laeger. 1996;158(47):6778-80. Available from: https://pubmed.ncbi.nlm.nih.gov/8992699/
  2. Horn B, Kiszel J. Milroy-Nonne-Meige disease observed in a pregnant woman. Zentralbl Gynakol. 1964;86:317-21.
  3. Cantegrel C. A case of acute lymphedema during the 6th month of pregnancy. Phlebologie. 1972;25(3):287-90. Available from: https://pubmed.ncbi.nlm.nih.gov/4662056/
  4. Aronsson A, Roscher I. Lymphoedema of the inner thighs in late pregnancy. Acta Derm Venereol. 1997;77(3):249. Available from: https://doi.org/10.2340/0001555577249
  5. Biswas A, Kanti Kundu M, Kyal A, Ganguly RP, Sanyal P, Bhansali S, et al. Unilateral lower limb oedema in pregnancy. J Indian Med Assoc. 2007;105(10):598, 600, 602. Available from: https://pubmed.ncbi.nlm.nih.gov/18383955/
  6. Helwani MA, Donnelly JA, Makan M, De Wet CJ. A pregnant woman in the third trimester diagnosed with acute respiratory failure and severe lower-extremity edema. Chest. 2016;150(4):e105-e107. Available from: https://doi.org/10.1016/j.chest.2016.03.066
  7. Ochalek K. Three-year follow-up of the compression use in lower limb edema during pregnancy: A case report. J Vasc Nurs. 2021;39(2):43-46. Available from: https://doi.org/10.1016/j.jvn.2021.04.002
  8. Morimoto K, O’Rourke L. Third trimester lower extremity lymphorrhea. Case Rep Obstet Gynecol. 2021;2021:3594923. Available from: https://doi.org/10.1155/2021/3594923
  9. Bourgeois P. Methodological protocol for lymphoscintigraphy in limb edema. Belnuc 1–16. 2017. Available from: https://www.belnuc.be/news-test/
  10. Barbieux R, Roman MM, Rivière F, Leduc O, Leduc A, Bourgeois P, Provyn S. Scintigraphic investigations of the deep and superficial lymphatic systems in the evaluation of lower limb oedema. Sci Rep. 2019;9(1):13691. Available from: https://www.nature.com/articles/s41598-019-49554-7
  11. Smeltzer DM, Stickler GB, Schirger A. Primary lymphedema in children and adolescents: a follow-up study and review. Pediatrics. 1985;76(2):206-18. Available from: https://pubmed.ncbi.nlm.nih.gov/4022694/
  12. Brouillard P, Witte MH, Erickson RP, Damstra RJ, Becker C, Quéré I, et al. Primary lymphoedema. Nat Rev Dis Primers. 2021;7(1):77. Available from: https://doi.org/10.1038/s41572-021-00309-7
  13. Executive Committee of the International Society of Lymphology. The Diagnosis and Treatment of Peripheral Lymphedema: 2023 Consensus Document of The International Society of Lymphology. Lymphology. 2023;56(4):133-151. Available from: https://pubmed.ncbi.nlm.nih.gov/39207406/
  14. Vargo M, Aldrich M, Donahue P, Iker E, Koelmeyer L, Crescenzi R, et al. Current diagnostic and quantitative techniques in the field of lymphedema management: a critical review. Med Oncol. 2024;41(10):241. Available from: https://link.springer.com/article/10.1007/s12032-024-02472-9
  15. Markarian B, Toro C, Moreira K, Polam S, Mathew N, Mayrovitz HN. Assessment modalities for lower extremity edema, lymphedema, and lipedema: A scoping review. Cureus. 2024;16(3):e55906. Available from: https://doi.org/10.7759/cureus.55906
  16. Salehi BP, Sibley RC, Friedman R, Kim G, Singhal D, Loening AM, et al. MRI of lymphedema. J Magn Reson Imaging. 2023;57(4):977-991. Available from: https://doi.org/10.1002/jmri.28496
  17. Unno N, Inuzuka K, Suzuki M, Yamamoto N, Sagara D, Nishiyama M, et al. Preliminary experience with a novel fluorescence lymphography using indocyanine green in patients with secondary lymphedema. J Vasc Surg. 2007;45(5):1016-21. Available from: https://doi.org/10.1016/j.jvs.2007.01.023
  18. Han CY, Choi SH, Chi SH, Hong JH, Cho YE, Kim J. Nano-fluorescence imaging: advancing lymphatic system disease and monitoring. Nano Converg. 2024;11(1):53. Available from: https://nanoconvergencejournal.springeropen.com/articles/10.1186/s40580-024-00462-1
  19. Sevick-Muraca EM, Fife CE, Rasmussen JC. Imaging peripheral lymphatic dysfunction in chronic conditions. Front Physiol. 2023;14:1132097. Available from: https://doi.org/10.3389/fphys.2023.1132097
  20. Bourgeois P. Critical analysis of the literature on lymphoscintigraphic investigations of limbedemas. Eur J Lymphol Relat Probl. 1997;VI/21:1-21.
  21. Bourgeois P, Munck D, Becker C, Leduc O. Evaluation of a three-phase lymphoscintigraphic investigation protocol of the lower limbedemas. Eur J Lymphol Relat Probl. 1997;VI/21:22-28. Available from: https://www.researchgate.net/publication/292855898_A_three-phase_lymphoscintigraphic_investigation_protocol_for_the_evaluation_of_lower_limbedemas
  22. Szuba A, Shin WS, Strauss HW, Rockson S. The third circulation: radionuclide lymphoscintigraphy in the evaluation of lymphedema. J Nucl Med. 2003;44(1):43-57. Available from: https://pubmed.ncbi.nlm.nih.gov/12515876/
  23. Bourgeois P. Lymphoscintigraphy and other imaging methods. In: Green AK, Slavin SA, Brörson H, editors. Lymphedema: presentation, diagnosis, and treatment. Springer; 2015. Available from: https://doi.org/10.1371/journal.pone.0253900
  24. Quartuccio N, Agugliaro F, Alongi P, Sturiale L, Arnone G, Corrao S. A systematic review comparing lymphoscintigraphy and magnetic resonance imaging techniques in the assessment of peripheral lymphedema. Curr Med Imaging. 2022;19(5):469-475. Available from: https://doi.org/10.2174/1573405618666220525141721
  25. Kinmonth JB, Taylor GW, Harper RK. Lymphangiography: a technique for its clinical use in the lower limb. Br Med J. 1955;1(4919):940-2. Available from: https://doi.org/10.1136/bmj.1.4919.940
  26. Kinmonth JB, Taylor GW, Tracy GD, Marsh JD. Primary lymphoedema: clinical and lymphangiographic studies of a series of 107 patients in which the lower limbs were affected. Br J Surg. 1957;45(189):1-9. Available from: https://doi.org/10.1002/bjs.18004518902
  27. Browse NL, Stewart G. Lymphoedema: pathophysiology and classification. J Cardiovasc Surg (Torino). 1985;26(2):91-106. Available from: https://pubmed.ncbi.nlm.nih.gov/3884629/
  28. Burnand KM, Glass DM, Sundaraiya S, Mortimer PS, Peters AM. Popliteal node visualization during standard pedal lymphoscintigraphy for a swollen limb indicates impaired lymph drainage. AJR Am J Roentgenol. 2011;197(6):1443-8. Available from: https://doi.org/10.2214/ajr.11.6631
  29. Schlögel MJ, Brouillard P. Genetic causes of lymphedema. In: Greene AK, Slavin SA, Brorson H, editors. Lymphedema: presentation, diagnosis, and treatment. Springer Int Publ AG; Switzerland. Available from: https://link.springer.com/book/10.1007/978-3-319-14493-1

Figures:

Figure 1

Figure 1

Figure 1

Figure 2

Figure 1

Figure 3

Figure 1

Figure 4

Figure 1

Figure 5

Figure 1

Figure 6

Figure 1

Figure 7

Figure 1

Figure 8

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?