ANALYSIS OF LYMPHATIC DRAINAGE IN VARIOUS FORMS OF LEG EDEMA USING 2 COMPARTMENT LYMPHOSCINTIGRAPHY

The anatomical and functional status of the epifascial and subfascial lymphatic compartments was analyzed using two compartment lymphoscinti graphy in five groups of patients (total 55) with various forms of ede ma of the lower extremities. Digital whole body scintigraphy enabled s emiquantitative estimation of radiotracer transport with comparison of lymphatic drainage between those individuals without (normal) and tho se with leg edema by calculating the uptake of the radiopharmaceutical transported to regional lymph nodes. A visual assessment of the lymph atic drainage pathways of the legs was also performed In patients with cyclic idiopathic edema, an accelerated rate of lymphatic transport w as detected thigh lymph volume overload or dynamic insufficiency). In those with venous (phlebo)edemas, high volume lymphatic overload (dyna mic insufficiency) of the epifascial compartment was scintigraphically defected by increased tracer uptake in regional nodes. In patients wi th deep femoral venous occlusion (post-thrombotic syndrome), subfascia l lymphatic transport was uniformly markedly reduced (safety valve lym phatic insufficiency). On the other hand, in the epifascial compartmen t, lymph transport was accelerated, lit those patients with recurrent or extensive skirt ulceration, lymph transport was reduced. Patients w ith lipedema (obesity) scintigraphically showed no alteration in lymph atic transport. This study demonstrates that lymphatic drainage is not ably affected (except in obesity termed lipedema) in various edemas of the leg. Lymphatic drainage varied depending on the specific compartm ent and the pathophysiologic mechanism accounting for the edema. Two c ompartment lymphoscintigraphy is a valuable diagnostic tool for accura te assessment of leg edema of known and unknown origin.