The dermal lymphatics in lymphoedema visualized by indirect lymphography

Area of Science:

• Vascular Medicine
• Diagnostic Imaging
• Lymphatic System Research

Background:

• Direct lymphography is challenging for fine, initial dermal lymphatics.
• Water-soluble contrast media offer potential for improved visualization.
• Understanding peripheral lymphatic changes is crucial for lymphoedema diagnosis.

Purpose of the Study:

• To evaluate Iotasul for indirect lymphography of initial dermal lymphatics.
• To assess the utility of indirect lymphography in various lymphoedema types.
• To investigate the role of initial dermal lymphatics in primary lymphoedema.

Main Methods:

• Subepidermal infusion of Iotasul (indirect lymphography) was performed.
• Thirty-eight patients with diverse lymphoedema presentations were studied.
• Normal and pathological lymphatic structures were analyzed.

Main Results:

• Indirect lymphography successfully demonstrated initial dermal lymphatics in healthy subjects.
• Congenital lymphoedema showed absent initial lymphatics but present collectors.
• Lymphoedema praecox and tardum exhibited hyperplastic dermal lymphatics.
• Secondary lymphoedema revealed peripheral lymphatic distension and congestion.

Conclusions:

• Indirect lymphography is valuable for visualizing initial dermal lymphatics.
• This technique can help differentiate primary lymphoedema from secondary causes.
• It may aid in early lymphoedema diagnosis and surgical candidate selection.