Lymphoscintigraphy of a patient with secondary leg lymphoedema provides evidence for the existence of axillo-inguinal anastomotic pathways

Full text: The aim of treatment for lymphoedema is to open collateral pathways to allow lymph to pass any blocked or restricted region and to move across watershed areas. These areas and drainage territories have been postulated by Foldi and Kubic. Some groups have stated that in over 400 lymphoscintigrams they have not been able to corroborate tracer collateral pathways. However, we have been able to demonstrate the existence of axillo-inguinal anastomotic pathways. A 37-year-old female presented with leg oedema subsequent to a total abdominal hysterectomy and radiotherapy Lymphoscintigraphy was requested to assess lymphatic drainage of both legs to assist optimization of treatment.99Tcm-antimony trisulphide colloid was injected at each of four sites intra-dermally, in the first inter-digital space and latero-dorsal areas of each foot. Anterior images, these being from the feet to above the liver, were then performed at 40, 85, 180 and 307 min post-injection. From 40 min, and continuing throughout the study, isotope distribution representing dermal diffusion was seen throughout both limbs up to and including the pelvic area. Tracer was first observed in the axillary region at 85 min and at that time clear superficial anastomotic pathways were observable. The axillary nodes continued to appear throughout the rest of the study. As important as it was to localize the areas of dermal diffusion and lymphatic pathways in the lower limbs, the most significant discovery in this instance was the confirmation of the axillo-inguinal anastomotic pathways previously postulated by Foldi and Kubic. This should help to increase the confidence of those professionals involved in the treatment of lymphoedema