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Understanding Lymphatic Anatomy and Abnormalities at Imaging.

Elizabeth Lee1, David M Biko1, William Sherk1

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Radiographics : a Review Publication of the Radiological Society of North America, Inc
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Summary

This review details lymphatic abnormalities, from rare malformations to common secondary lymphedema. Medical imaging advances are crucial for diagnosing and understanding these complex lymphatic system disorders.

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Area of Science:

  • Radiology and medical imaging
  • Vascular anomalies
  • Lymphatic system physiology and pathology

Background:

  • Lymphatic abnormalities present a diverse spectrum, including rare lymphatic malformations (LMs) and common secondary lymphedema affecting millions.
  • The lymphatic system's complex anatomy and variable nomenclature complicate understanding.
  • Medical imaging is increasingly vital for elucidating lymphatic physiology and pathology.

Purpose of the Study:

  • To provide a comprehensive overview of lymphatic anatomy, pathology, and imaging findings.
  • To highlight the role of radiology in diagnosing and managing lymphatic disorders.
  • To cover both common and uncommon lymphatic conditions based on current classifications.

Main Methods:

  • Review of normal and variant lymphatic anatomy.
  • Discussion of various imaging modalities: nuclear medicine lymphoscintigraphy, conventional lymphangiography, and MR lymphangiography.
  • Categorization of lymphatic disorders using the International Society for the Study of Vascular Anomalies 2018 classification.

Main Results:

  • Detailed description of imaging findings for primary lymphatic malformations (microcystic, mixed, macrocystic) and primary lymphedema.
  • Explanation of imaging approaches for secondary central lymphatic disorders, including secondary lymphedema and chylous leaks.
  • Inclusion of lymphatic disorders not easily classified.

Conclusions:

  • Radiology plays a critical role in the diagnosis and treatment of a wide array of lymphatic conditions.
  • Understanding lymphatic anatomy and pathology through advanced imaging is essential.
  • This review offers a valuable resource for clinicians managing patients with lymphatic disorders.