W. Williams

Radionuclide lymphangioscintigraphy in the evaluation of peripheral lymphedema.

PURPOSE The primary difficulty in evaluating and treating peripheral lymphedema is visualization of the lymphatics. Functional lymphatic studies have been performed on patients with peripheral edema to diagnose lymphedema, to determine its severity, and to understand the varied drainage patterns. METHODS After intradermal injection in the hands or feet, initial flow and whole-body images were taken using Tc-99m human serum albumin in more than 700 patients with possible lymphedema. RESULTS Clear images of truncal lymph transport and draining lymph nodes were obtained, and pattern differences between primary and secondary lymphedema were seen. Follow-up studies showed any functional change in lymphatic dynamics. CONCLUSION Peripheral lymphatics can now be easily visualized. Because lymphangioscintigraphy can be performed before and after medical treatment, follow-up evaluation of patients with lymphedema is possible. The procedure is noninvasive, repeatable, easy to perform, and harmless to the lymphatic endothelium.

Bilateral Warthin's tumor.

A case report of bilateral mixed Warthins tumors with nonuniform uptake demonstrated by Tc-99m pertechnetate imaging is presented. The findings are compared to CT, surgical, and pathology results.

Radioscintigraphic demonstration of unsuspected urine extravasation.

Three cases of unsuspected urine extravasation first detected by radionuclide scintigraphy are presented with subsequent confirmation by CT and, retrograde pyelograms. A renal study done to rule out acute transplant rejection demonstrates gallbladder uptake which was initially thought to be consistent with urine extravasation.

Extrinsic compression of an iliac vein mimicking inferior vena cava obstruction.

A case of anterior extrinsic compression of the left external iliac vein is presented. The impaired flow produces a pattern in a left lower extremity radionuclide venogram initially thought to be consistent with inferior vena cava obstruction.