Intestinal lymphangiectasia: Evaluation by CT and scintigraphy

Puri, Ajay; Aggarwal, Rakesh; Gupta, Ranjan; Sewatkar, A. B.; Gambhir, Sanjay; Tandon, Pradeep; Choudhuri, Gourdas

doi:10.1007/bf01888524

Cited by 31 publications

(20 citation statements)

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“…99m Tc human serum albumin has been used successfully to image PLE. 10,[13][14][15] However, it is not an ideal radiotracer. Problems have been reported with in vivo chemical stability, with marked dissociation documented over 24 hours, 35 with variable radiolabelling efficiency even within the one batch, with reduced specificity as up to 30% of the activity is in the free or reduced form, and with significant radiation burden on the liver.…”

Section: Discussionmentioning

confidence: 99%

“…Several radiopharmaceuticals have been used, including indium-111 ( 111 In) -transferrin 12 and technetium-99m ( 99m Tc)-human serum albumin. 10,[13][14][15] However 99m Tc-dextran appears to be superior as it is a more chemically stable compound, provides a higher target to-background activity ratio, and false-positive studies are less likely. 16 It has been reported that intestinal lymphangiectasia and PLE may respond to small bowel resection where the disease process is confined to a relatively small segment of the bowel.…”

mentioning

confidence: 99%

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Successful Resection of Localized Intestinal Lymphangiectasia Post-Fontan: Role of 99mTechnetium-Dextran Scintigraphy

et al. 2003

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ABSTRACT. Intestinal lymphangiectasia is a well-recognized complication of the Fontan procedure, occurring in up to 24% of patients. Because of the loss of chylous fluid into the gut lumen, protein-losing enteropathy results as well as lymphopenia and hypogammaglobulinaemia. In some cases, dilated lymphatics in the intestinal serosa or mesentery also rupture, causing chylous ascites. Standard medical and cardiac surgical interventions are generally ineffective and the condition is frequently lethal. We report a case of intractable and lifethreatening chylous ascites and chylothorax in a 14-yearold girl, associated with intestinal lymphangiectasia and protein-losing enteropathy after a Fontan procedure for tricuspid atresia. The condition was refractory to all standard medical therapies, including dietary modifications, diuretics, corticosteroid therapy, albumin infusions, octreotide, heparin, bowel rest, and parenteral nutrition. Cardiac surgery to optimize her hemodynamic status was also ineffective and large volume pleural and ascitic fluid losses continued. Having exhausted all other therapeutic modalities, 99m technetium-dextran scintigraphy was performed to assess the extent of intestinal protein loss and the potential for surgical intervention. Scintigraphy suggested localized protein loss from the proximal jejunum and subsequent segmental resection was effective. Postoperatively, ascites and pleural effusions resolved, and there was no evidence of short bowel syndrome. Growth has accelerated and the patient has entered puberty. There is mild persistent intestinal protein loss requiring diuretic therapy. Ascites or pleural effusions are absent, and the patient remains well >2 years after surgery. Intestinal lymphangiectasia postFontan procedures has traditionally been ascribed to hemodynamic factors such as raised systemic venous pressure, which would predispose to a generalized intestinal lesion. However, in this case, scintigraphy demonstrated a localized, surgically correctible lesion. To our knowledge, this is the first reported case of the use of 99m technetium-dextran scintigraphy for this indication and of successful partial small bowel resection in such a case. Pediatrics 2003;112:e242-e247. URL: http://www. pediatrics.org/cgi/content/full/112/3/e242; intestinal lymphangiectasia, resection, Fontan procedure, 99m technetium-dextran, scintigraphy.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Successful Resection of Localized Intestinal Lymphangiectasia Post-Fontan: Role of 99mTechnetium-Dextran Scintigraphy

et al. 2003

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“…A wide variety of radionucleotides have been used for this purpose, including technetium (Tc)-99 m-human serum albumin and other Tc-99m-labeled substances, as well as 111In transferrin (Saverymuttu et al, 1983;Puri et al, 1992;Bhatnagor et al, 1995a;Chiu et al, 2001). These techniques do yield positive scintigraphs in cases of PLE, but it is not clear that they are sensitive enough to pick up low-level abnormalities; in addition, although these techniques can conceivably provide rough estimates of the severity of PLE, they are not truly quantitative.…”

Section: Results Of Metabolic Studiesmentioning

confidence: 99%

“…Finally, the advent of scintigraphy (Saverymuttu et al, 1983;Puri et al, 1992;Bhatnagor et al, 1995b) has opened the possibility of identifying the presence of a localized lymphatic abnormality in a particular segment of the bowel and, thus, the possibility of surgical treatment of the IL (Kinmonth and Cox, 1974;Fox and Lucani, 1993;Persic et al, 1998;Kim et al, 2009). Suffice it to say that the efficacy of this approach has yet to be clearly proved.…”

Section: Diagnosis and Treatmentmentioning

confidence: 94%

“…These include ultrasonography, which provides information about the mesenteric lymphatics and the presence of ascites, as well as scintigraphy, which provides information about the size and location of the intestinal leak, as discussed previously (Saverymuttu et al, 1983;Puri et al, 1992;Bhatnagor et al, 1995b;Chiu et al, 2001).…”

Section: Endoscopic and Radiologic Findingsmentioning

confidence: 98%

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