Lymphoscintigraphy of Chylous Anomalies: Chylothorax, Chyloperitoneum, Chyluria, and Lymphangiomatosis—15-Year Experience in a Pediatric Setting and Review of the Literature

Abstract

In the pediatric setting, lymphoscintigraphy is used mostly for the evaluation of lymphedema. Only a few cases of chylous anomalies and lymphatic malformations imaged with lymphoscintigraphy have been reported in the literature. The aim of this study was to review the use of lymphoscintigraphy in those pathologies. All lymphoscintigraphy studies performed for chylous anomalies between 2001 and 2017 in our hospital were retrospectively reviewed. The results were correlated to clinical and radiologic findings. Lymphoscintigraphy consisted of sequential imaging after injection of 3.7-9.25 MBq (100-250 μCi) ofTc-filtered sulfur colloid at the level of the feet or hands. Twenty-five studies were performed on 21 patients. Fourteen studies were obtained for the evaluation of chylothorax. Eleven were performed for chyloperitoneum, chyluria, chylopericardium, exudative enteropathy, or lymphangiomatosis. Ten studies were positive for lymphatic leakage, and 1 had uncertain results. After correlation with radiologic findings and follow-up, there were 7 true-negative and 5 false-negative results (previousGa-interfering activity in 1, injection in only the hands in 3, and a low-fat diet in 1). One study became positive after injection in the feet, and another became positive after a switch to a high-fat diet. Lymphoscintigraphy is a useful tool for imaging lymphatic anomalies in children. Suggestions to optimize results include placing the patient on a high-fat diet, withholding octreotide, injecting the 4 extremities, and imaging with SPECT/CT.

Insufficient hepatic uptake in pediatric patients on lymphoscintigraphy

“…Lymphoscintigraphy was performed in patients with suspected lymphatic flow disorders, such as idiopathic hydrops fetalis, edema of limbs or genitalia, hydrothorax, hydroperitoneum, or ascites. 2,12,20,21,23,24 A dose of 50 MBq of Technetium-99m labeled human serum albumin-DTPA (99mTc-HSAD) was injected into the right and left dorsal pedis, and the injection sites were massaged. 16,17,20,22 A gamma camera (Siemens Symbia E or T16; Siemens Medical Systems Inc., Hoffmann Estates, IL, USA) equipped with a fan bema collimator was used.…”

“…2,[15][16][17] There have been some reviews and studies on lymphoscintigraphy; however, lymphatic flow disorder occasionally occurs in pediatric patients, especially in those with congenital cardiac disease or after surgical repair. 1,[18][19][20][21][22][23] There are also no reports evaluating the association between clinical outcomes and results of lymphoscintigraphy in pediatric patients.…”

Chylovenous bypass for mesenteric lymphangiomatosis: A case report

“…In such cases where the diagnosis of mesenteric lymphangiomatosis is based on intraoperative findings and imaging, ICG proves invaluable as a tool to characterize lymphatic drainage and likely can be applied in other instances where advanced preoperative imaging and direct intraoperative visualization are not entirely diagnostic or have pitfalls. 8 However, lymphangiomatosis and its pathophysiology, along with related diseases, still require further inquiry. Lymphangiomatosis is a disease where lymph or chyle accumulation result from the overgrowth of lymphatic tissue or vessels.…”

Whole-Body Lymphangioscintigraphy and Spect/Ct in Children With Lymphatic Complications After Surgery for Complex Congenital Heart Disease

“…Although symptoms may localize to a specific organ, lymphatic leaks can occur anywhere and thus a whole body approach should be undertaken. One well studied imaging modality for whole-body examination of lymphatic disorders is lymphangioscintigraphy (LAS), which has been recommended as the initial procedure of choice (11)(12)(13). LAS is minimally invasive, safe, and technically simple to perform (12).…”

“…One well studied imaging modality for whole-body examination of lymphatic disorders is lymphangioscintigraphy (LAS), which has been recommended as the initial procedure of choice (11)(12)(13). LAS is minimally invasive, safe, and technically simple to perform (12). As an imaging modality of whole-body lymphatic architecture, LAS has replaced direct lym-phography, which is more invasive, technically difficult, and carries risks such as oil injury lymphangiopathy and pulmonary oil embolism.…”