Lymphocutaneous fistulas: pre-therapeutic evaluation by magnetic resonance lymphangiography

Abstract

Objective: Lymphocutaneous fistulas with intractable lymphatic leakage represent a serious clinical condition leading to a severe impairment of quality of life for the affected patients. To date, no adequate diagnostic imaging modality is in existence to allow selection of the correct treatment option. The aim of this study was to perform a pre-therapeutic evaluation of the lymphatic system in patients with lymphocutaneous fistulas by magnetic resonance lymphangiography (MRL). Methods: Eight lower extremities in four patients with lymphocutaneous fistulas were examined by MRL. Three locations were examined: first, the lower leg and foot regions; second, the upper leg and the knee region; and third, the pelvic and retroperitoneal regions. A T 1 weighted three-dimensional (3D) spoiled gradient echo and a heavily T 2 weighted 3D turbo spin echo (3D-TSE) sequence were utilised to undertake MRL. Results: In all four patients (100%), the clinically suspected lymphocutaneous fistulas (groin and forefoot) were exactly delineated by MRL. In two patients (50%) adjacent diffuse lymphangiomatous changes were detected, extending into the upper leg, pelvis, retroperitoneum, abdomen and abdominal walls. In one patient (25%) with primary lymphoedema of the right lower extremity, MRL revealed an aplasia of the lymphatic collectors at the levels of the lower and upper leg. All patients (100%) suffered from an ipsilateral lymphoedema of the lower extremity, whereby in two patients with diffuse lymphangiomatosis the lymphatic vessels were consecutively enlarged up to a diameter of 6 mm. Conclusion: MRL is a safe and accurate imaging modality for a comprehensive evaluation of the lymphatic system in patients suffering from lymphocutaneous fistulas.

Lymphocutaneous Fistula

“…Magnetic resonance lymphangiography may be used to evaluate fistulas (5). As demonstrated here, ultrasound may be used for superficial fistulas.…”

Challenges and Solutions: Total Knee Replacement in Patients with Chronic Lymphatic Filariasis

“…These patients are at increased risk of periprosthetic fractures and tibial component loosening 6 . Postoperatively, the pneumatic compression stockings in the hospital setting and later manual lymphatic drainage after discharge help in the drainage of stagnant lymph, which could later be a source of infection and also in rare situations can produce lymphocutaneous fistula 7,8 . If the initial modalities fail to resolve the problems, patients have to be considered for other intervention including lymphovenous anastomosis (Table I).…”

Knee Lymphocutaneous Fistula Secondary to Knee Arthroplasty

“…We personally agree with Lohrmann's studies, in which MRL with intracutaneous injection of an extracellular paramagnetic contrast agent is considered to be a useful diagnostic imaging method for the evaluation of the lymphatic system. This imaging test is minimally invasive, lacks radiation, and bears no risks for the patient [ 12 – 14 ].…”