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Lymphoscintigraphy for the Differential Diagnosis of Peripheral Edema and Intracavitary Lymph Effusion

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Atlas of Lymphoscintigraphy and Sentinel Node Mapping

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Abstract

Patients with lower-extremity lymphedema initially present with unilateral painless swelling that starts on the dorsal aspect of the foot, but eventually progresses to involve the proximal portion of the limb. The edema is initially a pitting edema, but over time the subcutaneous tissue becomes fibrotic, resulting in nonpitting brawny edema. The edema can then spread circumferentially if treatment is not initiated, involving the skin, which becomes hyperkeratotic, hyperpigmented, and papillomatous or verrucous, with increased skin turgor. The Kaposi-Stemmer sign, in which the examiner is unable to pinch a fold of skin at the base of the second toe on the dorsal aspect of the foot, indicates clinical lymphedema [1–3]. Ultimately, the skin is at risk for ulcerating and subsequent infection. Swelling associated with lymphedema results in a sensation of heaviness, discomfort, and impaired mobility of the limb. Angiosarcoma may develop in chronic lymphedematous limbs (Stewart-Treves syndrome), but is most commonly seen in the upper extremity following mastectomy with axillary lymph node dissection [4]. This condition is often referred to as lymphangiosarcoma, which is actually a misnomer, since the tumor is not derived from lymphatic vessels, but is rather derived from vascular endothelial cells within a condition of chronic lymphedema.

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Authors and Affiliations

  1. Regional Center of Nuclear Medicine, University of Pisa Medical School, Pisa, Italy

    Paola Anna Erba, Martina Sollini & Roberto Boni

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  1. Paola Anna Erba
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  2. Martina Sollini
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  3. Roberto Boni
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Correspondence to Paola Anna Erba .

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Editors and Affiliations

  1. Regional Center of Nuclear Medicine, University of Pisa Medical School, Pisa, Italy

    Giuliano Mariani , Gianpiero Manca  & Federica Orsini ,  & 

  2. Nuclear Medicine, Hospital Clínic Barcelona, Barcelona, Spain

    Sergi Vidal-Sicart

  3. Nuclear Medicine, Division of Diagnostic Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands

    Renato A. Valdés Olmos

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Erba, P.A., Sollini, M., Boni, R. (2013). Lymphoscintigraphy for the Differential Diagnosis of Peripheral Edema and Intracavitary Lymph Effusion. In: Mariani, G., Manca, G., Orsini, F., Vidal-Sicart, S., Valdés Olmos, R.A. (eds) Atlas of Lymphoscintigraphy and Sentinel Node Mapping. Springer, Milano. https://doi.org/10.1007/978-88-470-2766-4_5

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  • DOI: https://doi.org/10.1007/978-88-470-2766-4_5

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