Lymphoscintigraphic Bilateral Disease in Patients with Clinically Unilateral Primary Lower Limb Lymphedemas

Primary lower limb lymphedemas (LLLEs; not present at birth) are classified as early- and late-onset. In both groups, distal lymphangiopathy distal dermal backflow (DDB) may be observed and, in clinically unilateral edema, abnormalities may be present at the level of contralateral limb. The aim of this study is to report the frequency of heterolateral lesions in these patients based on lymphoscintigraphic investigations (LySc). Retrospective review (CE2048) among our database of patients who were referred for LySc of clinically unilateral LLLE and for whose LySc showed DDB. Fifty-six patients could be classified as early-onset ("praecox": group 1: 8 men and 48 women: median age at investigation = 32.5 years: edema was right sided in 26 and left sided in 30) and 47 (8 men and 39 women: edema was right sided in 25 and left sided in 22) as late-onset ("tarda": group 2). DDB at the level of the opposite nonedematous limb was found in 38.8% of the whole series but more frequently (p < 0.001) in group 2 (70%) than in group 1 (15%). In group 1, bilateral disease were seen as frequently (in 4 cases) among the (33) patients <35 years old than in other patients (4 out of 23). These differences between these two clinical groups could support the following hypothesis: we are facing, either two different lymphatic diseases, or, a single disease but affecting two populations of different susceptibility.