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Congenital lymphatic hypoplasia in unilateral lower limb with abnormal technetium-99m sulphur colloid uptake in both breasts.

Padma S, Sundaram PS - Indian J Nucl Med (2014)

Bottom Line: Other possibilities include formation of spontaneous lymphovenous shunt or lymphatic intercommunication at lower trunk level as a result of increased pressure leading to minimal lymph accumulation in breasts.Later a mammogram was performed which was found to be normal.MR also confirmed no cisterna chyli abnormalities or aberrant lymphatic channels in lower thorax region that may be the explanation for the abnormal sulphur colloid uptake in both breasts.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine and PET CT, Amrita Institute of Medical Sciences, Cochin, Kerala, India.

ABSTRACT
We present a patient with Meige like lymphedema (left lower limb hypoplasia) with asymptomatic minimal accumulation of Technetium-99m sulfur colloid in bilateral breasts. We attribute the possible pathology to accumulation of interstitial fluid in hypoplastic left lower limb leading to dilatation of the remaining outflow tracts and valvular incompetence. This may be causing reversal of flow from subcutaneous tissues into the dermal plexus involving the breast. Other possibilities include formation of spontaneous lymphovenous shunt or lymphatic intercommunication at lower trunk level as a result of increased pressure leading to minimal lymph accumulation in breasts. Later a mammogram was performed which was found to be normal. MR also confirmed no cisterna chyli abnormalities or aberrant lymphatic channels in lower thorax region that may be the explanation for the abnormal sulphur colloid uptake in both breasts.

No MeSH data available.


Related in: MedlinePlus

Technetium-99m sulfur colloid lower limb lymphoscintigraphy: Normal lymphatic flow seen through right lower limb. No progression of colloid particles noted through left lower limb lymphatic channels in initial image. A few faint left inguinal nodes are visualized in delayed images. Findings suggest left lower limb lymphatic hypoplasia. Delayed image at 2 h also showed abnormal minimal accumulation of tracer in bilateral breasts (bold arrow) and lower trunk region (dotted arrow) suggesting abnormal lymphatic intercommunication at lower trunk level or reversal of lymphatic flow into breasts through Garota's paramammary route.
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Figure 1: Technetium-99m sulfur colloid lower limb lymphoscintigraphy: Normal lymphatic flow seen through right lower limb. No progression of colloid particles noted through left lower limb lymphatic channels in initial image. A few faint left inguinal nodes are visualized in delayed images. Findings suggest left lower limb lymphatic hypoplasia. Delayed image at 2 h also showed abnormal minimal accumulation of tracer in bilateral breasts (bold arrow) and lower trunk region (dotted arrow) suggesting abnormal lymphatic intercommunication at lower trunk level or reversal of lymphatic flow into breasts through Garota's paramammary route.

Mentions: Patient was referred to our department for lower limb lymphoscintigraphy to rule out any lymphatic dysfunction. 37 MBq of filtered technetium-99m (99mTc) Sulfur colloid in two equally divided doses were injected intradermally over first and second interdigital web spaces of feet. Initial images of lower limbs show good progression of colloid particles through right lower limb lymphatic channels with normal visualization of right inguinal lymph nodes. No progression of colloid particles noted through left lower limb lymphatic channels. A few left inguinal nodes were faintly seen in delayed images. Findings suggest unilateral left lower limb lymphatic hypoplasia [Figure 1]. In addition, abnormal colloid accumulation was noted in bilateral breasts (bold arrow) and lower trunk region (dotted arrow) appreciable only in 2 h delayed images. An abnormal lymphatic communication at lower trunk level was suspected. Further to lower limb lymphoscintigraphy, patient underwent clinical examination of breasts, and bilateral mammogram, which was found to be normal. Magnetic resonance (MR) [Figure 2] of thorax showed cisterna chyli as a single straight thin tube (thin arrow) between the aorta and the right hemidiaphragmatic crus thus ruling out any cisterna chyli malformation No aberrant lymphatics were also noted to explain the bialteral breast sulphur colloid uptake in this patient.


Congenital lymphatic hypoplasia in unilateral lower limb with abnormal technetium-99m sulphur colloid uptake in both breasts.

Padma S, Sundaram PS - Indian J Nucl Med (2014)

Technetium-99m sulfur colloid lower limb lymphoscintigraphy: Normal lymphatic flow seen through right lower limb. No progression of colloid particles noted through left lower limb lymphatic channels in initial image. A few faint left inguinal nodes are visualized in delayed images. Findings suggest left lower limb lymphatic hypoplasia. Delayed image at 2 h also showed abnormal minimal accumulation of tracer in bilateral breasts (bold arrow) and lower trunk region (dotted arrow) suggesting abnormal lymphatic intercommunication at lower trunk level or reversal of lymphatic flow into breasts through Garota's paramammary route.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4228596&req=5

Figure 1: Technetium-99m sulfur colloid lower limb lymphoscintigraphy: Normal lymphatic flow seen through right lower limb. No progression of colloid particles noted through left lower limb lymphatic channels in initial image. A few faint left inguinal nodes are visualized in delayed images. Findings suggest left lower limb lymphatic hypoplasia. Delayed image at 2 h also showed abnormal minimal accumulation of tracer in bilateral breasts (bold arrow) and lower trunk region (dotted arrow) suggesting abnormal lymphatic intercommunication at lower trunk level or reversal of lymphatic flow into breasts through Garota's paramammary route.
Mentions: Patient was referred to our department for lower limb lymphoscintigraphy to rule out any lymphatic dysfunction. 37 MBq of filtered technetium-99m (99mTc) Sulfur colloid in two equally divided doses were injected intradermally over first and second interdigital web spaces of feet. Initial images of lower limbs show good progression of colloid particles through right lower limb lymphatic channels with normal visualization of right inguinal lymph nodes. No progression of colloid particles noted through left lower limb lymphatic channels. A few left inguinal nodes were faintly seen in delayed images. Findings suggest unilateral left lower limb lymphatic hypoplasia [Figure 1]. In addition, abnormal colloid accumulation was noted in bilateral breasts (bold arrow) and lower trunk region (dotted arrow) appreciable only in 2 h delayed images. An abnormal lymphatic communication at lower trunk level was suspected. Further to lower limb lymphoscintigraphy, patient underwent clinical examination of breasts, and bilateral mammogram, which was found to be normal. Magnetic resonance (MR) [Figure 2] of thorax showed cisterna chyli as a single straight thin tube (thin arrow) between the aorta and the right hemidiaphragmatic crus thus ruling out any cisterna chyli malformation No aberrant lymphatics were also noted to explain the bialteral breast sulphur colloid uptake in this patient.

Bottom Line: Other possibilities include formation of spontaneous lymphovenous shunt or lymphatic intercommunication at lower trunk level as a result of increased pressure leading to minimal lymph accumulation in breasts.Later a mammogram was performed which was found to be normal.MR also confirmed no cisterna chyli abnormalities or aberrant lymphatic channels in lower thorax region that may be the explanation for the abnormal sulphur colloid uptake in both breasts.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine and PET CT, Amrita Institute of Medical Sciences, Cochin, Kerala, India.

ABSTRACT
We present a patient with Meige like lymphedema (left lower limb hypoplasia) with asymptomatic minimal accumulation of Technetium-99m sulfur colloid in bilateral breasts. We attribute the possible pathology to accumulation of interstitial fluid in hypoplastic left lower limb leading to dilatation of the remaining outflow tracts and valvular incompetence. This may be causing reversal of flow from subcutaneous tissues into the dermal plexus involving the breast. Other possibilities include formation of spontaneous lymphovenous shunt or lymphatic intercommunication at lower trunk level as a result of increased pressure leading to minimal lymph accumulation in breasts. Later a mammogram was performed which was found to be normal. MR also confirmed no cisterna chyli abnormalities or aberrant lymphatic channels in lower thorax region that may be the explanation for the abnormal sulphur colloid uptake in both breasts.

No MeSH data available.


Related in: MedlinePlus