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Gómez FM, Baetens TR, Santos E, Rocha BL, Horwitz B, Lojo-Lendoiro S, Vargas P, Patel P, Beets-Tan R, Martínez-Rodrigo JJ, Bonmatí LM. Interventional solutions for post-surgical problems: a lymphatic leaks review. CVIR Endovasc 2024; 7:61. [PMID: 39126551 PMCID: PMC11316727 DOI: 10.1186/s42155-024-00473-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024] Open
Abstract
The lymphatic circulation plays a crucial role in maintaining fluid balance and supporting immune responses by returning serum proteins and lipids to the systemic circulation. Lymphatic leaks, though rare, pose significant challenges post-radical neck surgery, oesophagectomy, and thoracic or retroperitoneal oncological resections, leading to heightened morbidity and mortality. Managing lymphatic leaks necessitates consideration of aetiology, severity, and volume of leakage. Traditionally, treatment involved conservative measures such as dietary restrictions, drainage, and medical management, with surgical intervention reserved for severe cases, albeit with variable outcomes and extended recovery periods. Lymphography, introduced in the 1950s, initially served as a diagnostic tool for lymphoedema, lymphoma, tumour staging, and monitoring chemotherapy response. However, its widespread adoption was impeded by alternative techniques like Computed Tomography, learning curves, and its associated complications. Contemporary lymphatic interventions have evolved, favouring nodal lymphangiography over pedal lymphangiography for its technical simplicity and reduced complexity. Effective management of chylous leaks mandates a multimodal approach encompassing clinical evaluation and imaging techniques. In cases where conservative management proves ineffective, embolization through conventional lymphangiography by bipedal dissection or intranodal injection emerges as a viable option. This review underscores the importance of a comprehensive approach to diagnosing and treating lymphatic leaks, highlighting advancements in imaging and therapeutic interventions that enhance patient outcomes.
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Affiliation(s)
- Fernando M Gómez
- Biomedical Imaging Research Group (GIBI2^30), La Fe Health Research Institute (IIS La Fe), Avenida Fernando Abril Martorell, València, 46026, Spain.
- Radiology Department, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell, València, 46026, Spain.
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands.
| | - Tarik R Baetens
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands
| | - Ernestos Santos
- Radiology, Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Boris León Rocha
- Department of Interventional Radiology, Hospital Clínico de la Universidad de Chile, Santos Dumont 999, Independencia, Región Metropolitana, Chile
| | - Benjamín Horwitz
- Radiology Department, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago, 7650568, Chile
| | - Sara Lojo-Lendoiro
- Department of Radiology, Hospital Álvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo, Pontevedra, 36312, Spain
| | - Patricio Vargas
- Radiology Department, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago, 7650568, Chile
| | - Premal Patel
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Regina Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands
| | - José J Martínez-Rodrigo
- Biomedical Imaging Research Group (GIBI2^30), La Fe Health Research Institute (IIS La Fe), Avenida Fernando Abril Martorell, València, 46026, Spain
| | - Luis Martí Bonmatí
- Biomedical Imaging Research Group (GIBI2^30), La Fe Health Research Institute (IIS La Fe), Avenida Fernando Abril Martorell, València, 46026, Spain
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Negm AS, Collins JD, Bendel EC, Takahashi E, Knavel Koepsel EM, Gehling KJ, Burke CE, Barker DR, Stenzel WS, Bathke AM, Polites SF, Abcejo AS, Morris JM, Favazza C, Lu A, François CJ, Young P, Thompson SM. MR Lymphangiography in Lymphatic Disorders: Clinical Applications, Institutional Experience, and Practice Development. Radiographics 2024; 44:e230075. [PMID: 38271257 DOI: 10.1148/rg.230075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Lymphatic flow and anatomy can be challenging to study, owing to variable lymphatic anatomy in patients with diverse primary or secondary lymphatic pathologic conditions and the fact that lymphatic imaging is rarely performed in healthy individuals. The primary components of the lymphatic system outside the head and neck are the peripheral, retroperitoneal, mesenteric, hepatic, and pulmonary lymphatic systems and the thoracic duct. Multiple techniques have been developed for imaging components of the lymphatic system over the past century, with trade-offs in spatial, temporal, and contrast resolution; invasiveness; exposure to ionizing radiation; and the ability to obtain information on dynamic lymphatic flow. More recently, dynamic contrast-enhanced (DCE) MR lymphangiography (MRL) has emerged as a valuable tool for imaging both lymphatic flow and anatomy in a variety of congenital and acquired primary or secondary lymphatic disorders. The authors provide a brief overview of lymphatic physiology, anatomy, and imaging techniques. Next, an overview of DCE MRL and the development of an MRL practice and workflow in a hybrid interventional MRI suite incorporating cart-based in-room US is provided, with an emphasis on multidisciplinary collaboration. The spectrum of congenital and acquired lymphatic disorders encountered early in an MRL practice is provided, with emphasis on the diversity of imaging findings and how DCE MRL can aid in diagnosis and treatment of these patients. Methods such as DCE MRL for assessing the hepatic and mesenteric lymphatic systems and emerging technologies that may further expand DCE MRL use such as three-dimensional printing are introduced. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Ahmed S Negm
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Jeremy D Collins
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Emily C Bendel
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Edwin Takahashi
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Erica M Knavel Koepsel
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Kathleen J Gehling
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Courtney E Burke
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Devin R Barker
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Wayne S Stenzel
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Angela M Bathke
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Stephanie F Polites
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Arnoley S Abcejo
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Jonathan M Morris
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Christopher Favazza
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Aiming Lu
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Christopher J François
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Phillip Young
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
| | - Scott M Thompson
- From the Department of Radiology, Division of Cardiovascular Imaging (A.S.N., J.D.C., E.T., D.R.B., W.S.S., C.F., A.L., C.J.F., P.Y., S.M.T.), Department of Radiology, Division of Vascular and Interventional Radiology (E.C.B., E.T., K.J.G., C.E.B., A.M.B., J.M.M., S.M.T.), Department of Surgery, Division of Pediatric Surgery (S.F.P.), and Department of Anesthesiology (A.S.A.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905; and Department of Radiology, Section of Interventional Radiology, University of Wisconsin, Madison, Wis (E.M.K.K.)
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