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Zhang L, Zhang X, Wen Z, Tong G, Hao K, Qiu Y, Kang L. Lymphoscintigraphy findings in patients with chylothorax: influence of biochemical parameters. EJNMMI Res 2023; 13:72. [PMID: 37535169 PMCID: PMC10400511 DOI: 10.1186/s13550-023-01014-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/25/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Chylothorax is a condition that can be challenging to diagnose due to its nonspecific clinical presentation. Several biochemical parameters of chylous pleural effusion have been identified as important indicators for the diagnosis of chylothorax. Lymphoscintigraphy is utilized to assess chylothorax and determine the location of chyle leakage. The present study aimed to evaluate the correlation between the biochemical parameters of chylous pleural effusion and 99mTc-dextran (99mTc-DX) lymphoscintigraphy in diagnosing chylothorax. MATERIAL AND METHODS A total of 120 patients were enrolled in the study, 83 of the patients with unilateral chylothorax, and 37 with bilateral chylothorax. All patients underwent both 99mTc-DX lymphoscintigraphy and pleural effusion laboratory analysis. The 99mTc-DX lymphoscintigraphy images were categorized as positive or negative groups based on the presence or absence of abnormal radioactive tracer accumulation in the thorax, respectively. The biochemical parameters of the two groups were subsequently compared. RESULTS Among these patients, 101 (84.17%) had exudative effusions, while 19 (15.83%) had transudative effusions, as determined by the levels of pleural effusion protein, lactate dehydrogenase and cholesterol. Abnormal tracer accumulation in thorax was observed in 82 patients (68.33%). Our findings indicated that lymphoscintigraphy results were not associated with exudative and transudative chylothorax (P = 0.597). The lymphoscintigraphy positive group displayed significantly higher levels of pleural effusion triglyceride and pleural effusion triglyceride/serum triglyceride ratio in all biochemical parameters, compared to the negative group (P = 0.000 and P = 0.005). We identified cutoff values of 2.870 mmol/L for pleural effusion triglycerides and 4.625 for pleural effusion triglyceride/serum triglyceride ratio, respectively, which can facilitate differentiating the positive and negative cases on lymphoscintigraphy. CONCLUSION Lymphoscintigraphy technique is a dependable diagnostic tool for the qualitative assessment of chylous pleural effusion. Higher pleural effusion triglyceride level and pleural effusion triglyceride/serum triglyceride ratio indicate a positive result in patients with chylothorax on lymphoscintigraphy, with the cutoff values of 2.870 mmol/L and 4.625 aiding in the diagnosis.
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Affiliation(s)
- Li Zhang
- Department of Nuclear Medicine, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tie Yi Rd, Haidian Dist., Beijing, 100038, China
| | - Xiaoyue Zhang
- Department of Nuclear Medicine, Peking University First Hospital, No. 8 Xishiku Str., Xicheng Dist., Beijing, 100034, China
| | - Zhe Wen
- Department of Nuclear Medicine, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tie Yi Rd, Haidian Dist., Beijing, 100038, China.
| | - Guansheng Tong
- Department of Nuclear Medicine, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tie Yi Rd, Haidian Dist., Beijing, 100038, China
| | - Kun Hao
- Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Yongkang Qiu
- Department of Nuclear Medicine, Peking University First Hospital, No. 8 Xishiku Str., Xicheng Dist., Beijing, 100034, China
| | - Lei Kang
- Department of Nuclear Medicine, Peking University First Hospital, No. 8 Xishiku Str., Xicheng Dist., Beijing, 100034, China.
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Lymphoscintigraphic Indications in the Diagnosis, Management and Prevention of Secondary Lymphedema. RADIATION 2023. [DOI: 10.3390/radiation3010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Secondary lymphedema is caused by damage to the lymphatic system, often following an oncological tumor removal intervention, or even by an accident. The diagnosis of lymphedema is not easy, because the disease can also be confused with other clinical manifestations (for example, venous insufficiency edema), though an experienced Lymphologist is usually able to diagnose it with good accuracy. To confirm the diagnosis, it is often necessary to resort to specialist imaging tests for an anatomo-functional definition of the pathology. Among these, lymphoscintigraphy is confirmed as the “gold standard” procedure for the diagnosis of lymphedema. Lymphoscintigraphy has been included in the Italian Guidelines by the Ministry of Health.
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Sun JD, Shum T, Behzadi F, Hammer MM. Imaging Findings of Thoracic Lymphatic Abnormalities. Radiographics 2022; 42:1265-1282. [PMID: 35960666 DOI: 10.1148/rg.220040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The lymphatic system plays an important role in balancing fluid compartments in the body. It is disrupted by various disease processes in the thorax, including injury to the thoracic lymphatic duct after surgery, as well as malignancy and heart failure. Because of the small size of lymphatic vessels, imaging of the lymphatics is relatively difficult, and effective imaging methods are still being optimized and developed. The standard of reference for lymphatic imaging has been conventional lymphangiography for several decades. Other modalities such as CT, noncontrast or contrast-enhanced MRI, and lymphoscintigraphy can also demonstrate lymphatic abnormalities and help in treatment planning. Imaging findings associated with lymphatic abnormalities can be seen in the pulmonary parenchyma, pleural space, and mediastinum. In the pulmonary parenchyma, common findings include interlobular septal thickening as well as reversal of lymphatic flow with intravasation of contrast material into pulmonary lymphatics. In the pleural space, findings include chylous pleural effusion and occasionally nonchylous pleural effusion. In the mediastinum, thoracic duct leak, plexiform thoracic duct, lymphatic malformations, and lymphangiectasis may occur. Management of chylothorax includes conservative or medical treatment, surgery, and interventional radiology procedures. The authors discuss thoracic lymphatic anatomy, imaging manifestations of lymphatic abnormalities in the various anatomic compartments, and interventional radiology treatment of chylothorax. Radiologists should be familiar with these imaging findings for diagnosis and to help guide appropriate management. ©RSNA, 2022.
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Affiliation(s)
- Jingshuo Derek Sun
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Thomas Shum
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Fardad Behzadi
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Mark M Hammer
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
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Suzuki N, Cintra FF, Cintra ML, Maciel MG, Amstalden EMI, Teixeira F, Kubba F. "A case of vanishing bone disease complicated by chylothorax- diagnosis and treatment". JRSM Open 2022; 13:20542704221103912. [PMID: 35774987 PMCID: PMC9237928 DOI: 10.1177/20542704221103912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 16-year old girl with Gorham-Stout disease is presented. She had progressive replacement of the bones of her left arm and shoulder girdle by fibroadipose tissue and numerous proliferated, non-neoplastic, lymphatic channels. The clinico-pathologic features of this condition are discussed, as are its possible complications and available therapeutic modalities.
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Affiliation(s)
- N Suzuki
- Department of Dermatology, Medical Sciences School, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - FF Cintra
- Department of Orthopedics, Medical Sciences School, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - ML Cintra
- Department of Pathology, Medical Sciences School, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - MG Maciel
- Department of Dermatology, Medical Sciences School, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - EMI Amstalden
- Department of Pathology, Medical Sciences School, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - F Teixeira
- Department of Pathology, Medical Sciences School, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - F Kubba
- Department of Pathology, London Northwest University Healthcare NHS Trust, UK
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Lymphoscintigraphy and lymphedema. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Hou G, Zhang Y, Chen L, Li F, Jing H. The relationship between the drainage function of inguinal lymph nodes and unilateral pelvic cancer-related lymphedema: A retrospective analysis. Medicine (Baltimore) 2021; 100:e28051. [PMID: 35049221 PMCID: PMC9191291 DOI: 10.1097/md.0000000000028051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/10/2021] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to investigate the relationship between iliolumbar lymph nodes (LNs), inguinal LNs, and unilateral pelvic cancer-related lymphedema by retrospective analysis of lymphoscintigraphy data.Ninety-six patients (3 men and 93 women; mean age, 53.3 ± 11.3 years) with pelvic cancer-related lymphedema were enrolled in this retrospective study. Lymphoscintigraphy was performed at 1 hour and 4 to 6 hours after injection. The visualization of inguinal LNs and iliolumbar LNs were recorded.According to statistical analysis, the display of inguinal LNs in lymphoscintigraphy has a significant negative correlation with ipsilateral lower limb lymphedema (P < .01, r = -0.561). However, there is no correlation between the show of iliolumbar LNs and ipsilateral lower extremity lymphedema (P = .056, r = -0.138). When lymphoscintigraphy was performed at 1 hour after injection, there were 13 out of 96 patients without inguinal LNs revealed on imaging, but at 4 to 6 hours after injection, inguinal LNs were seen in lymphoscintigraphy.The drainage function of inguinal LNs has a significant negative correlation with ipsilateral pelvic cancer-related lymphedema. Treatment dedicated to restoring the drainage function of LNs in the inguinal region may effectively relieve lymphedema. The image acquisition at 4 to 6 hours after injection is necessary for significant additional information.
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Affiliation(s)
- Guozhu Hou
- Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Yuwei Zhang
- Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Libo Chen
- Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Fang Li
- Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Hongli Jing
- Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
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Shen C, Che G, Wang Y. 99mTc-sulphur colloid lymphoscintigraphy and SPECT/CT in multiple primary lung cancer with chylothorax twice postoperatively. Quant Imaging Med Surg 2021; 11:4231-4234. [PMID: 34476205 DOI: 10.21037/qims-20-1205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/03/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Cheng Shen
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Guowei Che
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Yun Wang
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
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Blei F. Update December 2020. Lymphat Res Biol 2020. [DOI: 10.1089/lrb.2020.29096.fb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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