Investigations of lymphatics

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Investigations of lymphatics

  1. 1. By Kareem Hamimy 6 th year Medical Student Kasr al Ainy Medical School
  2. 2. <ul><li>Usually Clinical is enough </li></ul><ul><li>If typical, mild, no complicaions, </li></ul><ul><ul><li>No Need for investigations </li></ul></ul><ul><li>If atypical, Multifactorial Swelling </li></ul><ul><ul><li>Help to confirm </li></ul></ul><ul><ul><li>Inform management </li></ul></ul><ul><ul><li>Provide prognostic information </li></ul></ul>
  3. 3. <ul><li>Full blood count </li></ul><ul><li>Blood Sugar level </li></ul><ul><li>Urea and electrolytes </li></ul><ul><li>Creatinine </li></ul><ul><li>Liver, thyroid function tests </li></ul><ul><li>Chest x-ray </li></ul><ul><li>Urine dipstick (chyluria) </li></ul><ul><li>Blood smear (microfilaria) </li></ul>
  4. 4. Direct Indirect
  5. 5. <ul><li>Principle ?? (Dye-Inject- Oily- PLV-contrast-Radiographic) </li></ul><ul><li>Was Gold Stndard, Now Obsolete (why ?) </li></ul><ul><ul><ul><li>Surgical exposure </li></ul></ul></ul><ul><ul><ul><li>Damage to the lymphatic endothelium by oil </li></ul></ul></ul><ul><ul><ul><li>Pulmonary oil embolism </li></ul></ul></ul><ul><ul><ul><li>Wound infection </li></ul></ul></ul><ul><li>Used in Few Cases </li></ul><ul><ul><ul><li>Preoperative MegaLymphatics considered for bypass or fistula ligation </li></ul></ul></ul>
  6. 6. <ul><li>Principle?? ( Inject- Intradermal- nonionic contrast- Radiographic) </li></ul><ul><li>Shows the Distal lyphatics but not normally proximal lymphatics </li></ul>
  7. 8. <ul><li>Gold Standard Now </li></ul><ul><li>Principle ?? ( Radioactive technitium ptn – colloid particles- interdigital Webspaces- serial radiograph gamma camera </li></ul><ul><li>high-resolution imaging of peripheral lymphatic vessels </li></ul><ul><li>provides insight into lymph flow dynamics. </li></ul><ul><li>helps evaluate lymphatic truncal anatomy and radiotracer transport. </li></ul><ul><li>It can also be used to evaluate the efficacy of various treatment options designed to facilitate lymph flow or reduce lymph formation. </li></ul>
  8. 9. <ul><li>The procedure is essentially noninvasive, can easily be repeated, and does not adversely affect the lymphatic vascular endothelium. </li></ul>
  9. 10. Arms Legs
  10. 11. <ul><li>Axial Computerised tomography </li></ul><ul><li>To Exclude Tumours Causing Edema </li></ul><ul><li>Also lymphedema can appear in CT ( As Coarse, non enhancing, reticular, honey comb pattern in an enlarged subcutaneous compartment) </li></ul>
  11. 12. <ul><li>Magnetic resonance Imaging </li></ul><ul><li>Clear Images of lymphatic Channels and lymph nodes </li></ul><ul><li>Useful in pts with lymphatic hyperplasia </li></ul><ul><li>Distinguish between Venous and lymphatic </li></ul><ul><li>shows tumours causing obstructions </li></ul><ul><li>Expensive </li></ul>
  12. 13. <ul><li>Shows venous abnormality </li></ul><ul><li>For Filariasis </li></ul>
  13. 14. <ul><li>Where Malignancy is suspected </li></ul><ul><li>Lymph node biopsy </li></ul><ul><li>Skin Biopsy where lymphangiosarcoma is suspected </li></ul>
  14. 21. <ul><li>Right leg lymphedema and groin mass in a 72-year-old man. </li></ul><ul><li>Clinical photograph shows marked enlargement of the right leg. </li></ul><ul><li>Presurgical lymphangioscintigrams obtained 35 minutes (left) and 4½ hours (right) after injection of radiotracer demonstrate prominent dermal backflow in the right leg with intact trunks superiorly, findings that are suggestive of secondary lymphedema </li></ul><ul><li>CT, MRI Showing Cystic mass very near to the Hip Joint </li></ul><ul><li>Clinical photograph taken 6 weeks after excision of a large synovial cyst demonstrates resolution of overt edema </li></ul>
  15. 22. <ul><li>Bailey and Love: Short Practice of Surgery </li></ul><ul><li>http://radiographics.rsna.org/content/20/6/1697.full </li></ul>

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