Lymphoscintigraphy in the diagnosis of lymphatic leak after surgical repair of femoral artery injury

Purpose: Technetium-99m-labeled sulfur colloid lymphoscintigraphy is useful to evaluate lower extremity lymphatic circulation in cases of possible lym phedema and to reveal abnormal lymphatic collections, Groin lymphatic fistu las and lymphoceles are known complications of peripheral vascular surgical procedures. The authors describe a patient with ascites that developed int o right lower extremity swelling after surgical repair of a femoral artery injury, Even after surgical ligation of multiple lymphatic channels, the pa tient continued to have lymphorrhea. It was unclear whether this was attrib utable to a persistent lymphatic leak or an ascitic leak from a postsurgica l defect resulting in an abnormal connection with the peritoneal cavity, Methods: Lymphoscintigraphy of the lower extremities was performed using Tc -99m sulfur colloid, Images were obtained at several intervals after inject ion of the radiotracer. Images were also acquired after the wound packing w as removed, Results: The images revealed an accumulation of radiotracer in the right gr oin, confirming the lower extremity lymphatic origin of the collection, Con clusions: Lymphoscintigraphy is useful to evaluate the origin of serous col lections in the groin, a region in which lymphatic complications of vascula r surgery are not uncommon.