Lymphoscintigraphy in lymphedema of the lower limbs using 99mTc HSA

Edema of the lower limbs is a difficult clinical problem. Edema could be due to stasis, obstruction of the lymphatic channels, or increased production of lymph beyond the drainage capacity of the lymphatic vessels. Sometimes it is difficult to differentiate among these varieties. Lymphoscintigraphy was performed in 164 patients complaining of swelling of the lower limbs, 2 women patients with lymphedema of the upper limbs following radical mastectomy, and 5 volunteers. All patients were injected with 1 mCi of 99mTc human serum albumin intradermally in the medial web on the dorsum of each foot. Data were acquired dynamically for both inguinal regions for forty-five minutes with a gamma camera interfaced with a computer. Static images were taken at ninety minutes for both legs and thighs and for the pelvis. Time activity curves were generated for the equal regions of inguinal nodes on both inguinal sides. The following patterns were recognized: normal pattern in 5 volunteers and in 57 patients, enhanced flow pattern in 17 patients, stasis with mild obstruction in 72 patients, and marked stasis with obstruction in 20 patients.