Use of Contrast-Enhanced Ultrasound in Genital Lymphedema: A Report of Three Cases

Genital lymphedema presents significant challenges in surgical management, with limited effective interventions. This case report explores the use of contrast-enhanced ultrasound (CEUS) with microbubble injection as an alternative adjunct technique for lymphatic mapping in lymphaticovenous anastomosis (LVA) surgery for genital lymphedema. A retrospective chart review approved by our institutional review board was performed for patients with genital lymphedema undergoing LVA surgery between 2020 and 2024. Intraoperative CEUS for lymphatic mapping was used with intradermal injection of microbubble suspension Lumason (Bracco Suisse, Monroe Township, NJ, USA). Data regarding demographics, comorbidities, clinical and operative characteristics, complications, and surgical outcomes were retrieved. Three patients with genital lymphedema who underwent LVA were identified. The first patient was a 34-year-old female with recurrent lymphangioma circumscriptum and vesicular drainage. She successfully underwent CEUS-guided LVA followed by two debulking procedures. The second patient was a 16-year-old male with congenital scrotal and lower extremity lymphedema. He had two CEUS-guided LVAs and subsequent debulking for anterior scrotal swelling, with long-term reduction in edema. The third patient was a 31-year-old female with primary lymphedema of the right lower extremity and genital region. She underwent seven CEUS and indocyanine green lymphography (ICG) guided anastomoses targeting the mons and lower abdomen, resulting in substantial symptomatic and volumetric improvement. CEUS detected target lymphatic vessels in all cases, including cases where ICG imaging failed to identify candidate lymphatic vessels. CEUS with intradermal microbubble injection successfully identified target lymphatic vessels in the preoperative planning for LVA surgery in patients with genital lymphedema.