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Investigations of lymphatics
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Investigations of lymphatics

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  • 1. By Kareem Hamimy 6 th year Medical Student Kasr al Ainy Medical School
  • 2.
    • Usually Clinical is enough
    • If typical, mild, no complicaions,
      • No Need for investigations
    • If atypical, Multifactorial Swelling
      • Help to confirm
      • Inform management
      • Provide prognostic information
  • 3.
    • Full blood count
    • Blood Sugar level
    • Urea and electrolytes
    • Creatinine
    • Liver, thyroid function tests
    • Chest x-ray
    • Urine dipstick (chyluria)
    • Blood smear (microfilaria)
  • 4. Direct Indirect
  • 5.
    • Principle ?? (Dye-Inject- Oily- PLV-contrast-Radiographic)
    • Was Gold Stndard, Now Obsolete (why ?)
        • Surgical exposure
        • Damage to the lymphatic endothelium by oil
        • Pulmonary oil embolism
        • Wound infection
    • Used in Few Cases
        • Preoperative MegaLymphatics considered for bypass or fistula ligation
  • 6.
    • Principle?? ( Inject- Intradermal- nonionic contrast- Radiographic)
    • Shows the Distal lyphatics but not normally proximal lymphatics
  • 7.  
  • 8.
    • Gold Standard Now
    • Principle ?? ( Radioactive technitium ptn – colloid particles- interdigital Webspaces- serial radiograph gamma camera
    • high-resolution imaging of peripheral lymphatic vessels
    • provides insight into lymph flow dynamics.
    • helps evaluate lymphatic truncal anatomy and radiotracer transport.
    • It can also be used to evaluate the efficacy of various treatment options designed to facilitate lymph flow or reduce lymph formation.
  • 9.
    • The procedure is essentially noninvasive, can easily be repeated, and does not adversely affect the lymphatic vascular endothelium.
  • 10. Arms Legs
  • 11.
    • Axial Computerised tomography
    • To Exclude Tumours Causing Edema
    • Also lymphedema can appear in CT ( As Coarse, non enhancing, reticular, honey comb pattern in an enlarged subcutaneous compartment)
  • 12.
    • Magnetic resonance Imaging
    • Clear Images of lymphatic Channels and lymph nodes
    • Useful in pts with lymphatic hyperplasia
    • Distinguish between Venous and lymphatic
    • shows tumours causing obstructions
    • Expensive
  • 13.
    • Shows venous abnormality
    • For Filariasis
  • 14.
    • Where Malignancy is suspected
    • Lymph node biopsy
    • Skin Biopsy where lymphangiosarcoma is suspected
  • 15.  
  • 16.  
  • 17.  
  • 18.  
  • 19.  
  • 20.  
  • 21.
    • Right leg lymphedema and groin mass in a 72-year-old man.
    • Clinical photograph shows marked enlargement of the right leg.
    • 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
    • CT, MRI Showing Cystic mass very near to the Hip Joint
    • Clinical photograph taken 6 weeks after excision of a large synovial cyst demonstrates resolution of overt edema
  • 22.
    • Bailey and Love: Short Practice of Surgery
    • http://radiographics.rsna.org/content/20/6/1697.full
  • 23.