THE VALUE OF LYMPHOSCINTIGRAPHY WITH TECHNETIUM-99m HUMAN SERUM ALBUMIN IN THE DIAGNOSIS OF LIMB EDEMA SUSPECTED TO BE DUE TO LYMPHATIC OBSTRUCTION: A CASE REPORT
Main Article Content
Abstract
Background: Lymphedema is a chronic disorder of the lymphatic system characterized by interstitial fluid accumulation resulting from impaired or obstructed lymphatic drainage. Its clinical manifestations are often nonspecific, making early diagnosis challenging. Lymphoscintigraphy is a nuclear medicine technique that enables direct functional assessment of the lymphatic system and is currently regarded as the gold standard for the diagnosis of lymphedema.
Case summary: We report the case of a 57-year-old female patient who was admitted with long-standing swelling of the left lower limb. She had no history of surgery or trauma. Doppler ultrasound of the lower extremity veins showed no evidence of venous thrombosis or valvular insufficiency. Clinical examination revealed firm edema of the left lower limb, classified as grade IV according to the Cheng classification, raising suspicion of lymphedema.
Intervention and outcome: Lower-limb lymphoscintigraphy using Technetium-99m Human Serum Albumin (99mTc-HSA) demonstrated complete lymphatic obstruction of the left lower limb (T4 according to the Cheng classification), characterized by radiotracer retention at the injection site, dermal backflow, and absence of visualization of inguinal–iliac lymph nodes. The patient subsequently underwent lymphatic reconstruction using autologous vein grafting. After one month of follow-up, a marked improvement in limb edema was observed.
Conclusion: This case illustrates the role of lymphoscintigraphy in supporting the diagnosis and staging of lymphedema, while also guiding treatment selection and evaluating the effectiveness of surgical interventions.
Article Details
Keywords
Lymphoscintigraphy; limb edema; lymphedema; Technetium-99m HSA.
References
2. Szuba A, Shin WS, Strauss HW, Rockson S. The Third Circulation: Radionuclide Lymphoscintigraphy in the Evaluation of Lymphedema. J Nucl Med. 2003;44(1):43–57. PMID: 12515876
3. Vargo M, Aldrich M, Donahue P, Iker E, Koelmeyer L, Crescenzi R, et al. Current diagnostic and quantitative techniques in the field of lymphedema management: a critical review. Med Oncol. 2024;41(10):241. DOI: 10.1007/s12032-024-02472-9
4. Mango L. Lymphoscintigraphic Indications in the Diagnosis, Management and Prevention of Secondary Lymphedema. Radiation. 2023;3(1):40–45. DOI: 10.3390/radiation3010004
5. Pappalardo M, Cheng MH. Lymphoscintigraphy for the diagnosis of extremity lymphedema: Current controversies regarding protocol, interpretation, and clinical application. J Surg Oncol. 2020;121(1):37–47. DOI: 10.1002/jso.25526
6. Hassanein AH, Maclellan RA, Grant FD, Greene AK. Diagnostic Accuracy of Lymphoscintigraphy for Lymphedema and Analysis of False-Negative Tests. Plast Reconstr Surg – Glob Open. 2017;5(7):e1396. DOI: 10.1097/GOX.0000000000001396
7. Maccauro M, Villa G, Manzara A, Follacchio GA, Manca G, Tartaglione G, et al. Lymphoscintigraphy for the evaluation of limb lymphatic flow disorders: Report of technical procedural standards from an Italian Nuclear Medicine expert panel. Rev Esp Med Nucl E Imagen Mol Engl Ed. 2019;38(5):335–340. DOI: 10.1016/j.remn.2019.02.005
8. Maccauro M, Villa G, Manzara A, Follacchio GA, Manca G, Tartaglione G, et al. Linfogammagrafía para la evaluación de trastornos del flujo linfático de las extremidades: informe de estándares de procedimientos técnicos de un panel de expertos de medicina nuclear italiano. Rev Esp Med Nucl E Imagen Mol. 2019;38(5):335–340. DOI: 10.1016/j.remn.2019.02.005
9. Li Q, Tang Q, Luo K, Zhang S, Zhou X, Yang Y, et al. Comparative analysis of the International Society of Lymphology and Taiwan Lymphoscintigraphy Staging systems: correlation, reliability, and a quantitative severity index in extremity lymphedema. Quant Imaging Med Surg. 2025;15(3):1822–1833. DOI: 10.21037/qims-24-1926