Imaging of Perirenal and Intrarenal Lymphatic Vessels: Anatomy-based Approach

Radiological Imaging Findings of Adrenal Abnormalities in TAFRO Syndrome: A Systematic Review

“…These anatomical features may explain the following unexplained characteristics in TAFRO syndrome: first, paraaortic edema and perirenal edema were observed in almost all cases in patients with early stage TAFRO syndrome, even in those without pleural effusion or ascites [7]. This suggests that there is a mechanism by which edema in TAFRO syndrome first develops in the perirenal and paraaortic regions, which are involved in the perirenal and adrenal lymphatic systems [30,32]. Second, adrenal disorders, including adrenal ischemia, adrenal hemorrhage, and adrenomegaly, were frequently observed in patients with TAFRO syndrome, as we reported in previous and present studies [7].…”

“…To clarify the involvement of the perirenal and adrenal lymphatic systems in TAFRO syndrome, it is necessary to visualize the lymphatic systems. Takahashi et al [32] introduced several techniques to visualize the lymphatic systems potentially applied for investigating perirenal and adrenal lymphatic systems in patients with TAFRO syndrome: first, delayed contrast-enhanced CT scans (i.e., CT urography); second, CT lymphangiography performed with conventional lymphangiography using an ethiodized oil-based contrast agent or after injecting an iodinated water-soluble contrast agent via the transabdominal access of the cisterna chyli with CT guidance; and third, MR lymphangiography using non-enhanced heavily T2-weighted imaging to depict fluid-filled lymphatic vessels and three-dimensional fat-saturated T1-weighted gradient-echo imaging after the subcutaneous or intranodal injection of gadolinium-based contrast agent. Further studies using these techniques are warranted to verify the hypothesis that perirenal and adrenal lymphatic systems are frequently involved and cause adrenal abnormalities in patients with TAFRO syndrome.…”

“…Both the adrenal lymphatic systems and the perirenal lymphatic systems involve the adrenal glands. The perirenal lymphatic system has four major portions, namely, the renal hilar lymphatics, capsular lymphatics, communicating pericapsular lymphatics, and subfascial lymphatics [32]. The renal hilar lymphatics involve adrenal glands [32].…”

“…The perirenal lymphatic system has four major portions, namely, the renal hilar lymphatics, capsular lymphatics, communicating pericapsular lymphatics, and subfascial lymphatics [32]. The renal hilar lymphatics involve adrenal glands [32]. Matsumoto et al [33] reported that by using a heavily T2-weighted three-dimensional MRI sequence, these lymphatic vessels can be frequently and clearly identified, with the highest detectability in the renal hilar lymphatics, which involve the adrenal glands [32].…”

“…The renal hilar lymphatics involve adrenal glands [32]. Matsumoto et al [33] reported that by using a heavily T2-weighted three-dimensional MRI sequence, these lymphatic vessels can be frequently and clearly identified, with the highest detectability in the renal hilar lymphatics, which involve the adrenal glands [32]. These anatomical features may explain the following unexplained characteristics in TAFRO syndrome: first, paraaortic edema and perirenal edema were observed in almost all cases in patients with early stage TAFRO syndrome, even in those without pleural effusion or ascites [7].…”