IMLS images are digitized and the three dimensional coordinates are obtained. Tracer was not visualized superior to the inguinal region. A single femoral lymph node is identified, although the major pelvic lymph nodes are not seen. The cutaneous flare is diagnostic of lymphedema on lymphoscintigraphy. Diagnosis Lymphedema secondary to obstruction by radiation induced fibrosis.
Lymphatic vessels drain into the thoracic duct, which drains into the left subclavian vein.
Visualization of the liver confirms patent communication of the lymphatic system with the venous system. Lymphedema typically manifests as a 'veil' of tracer activity1 on delayed views which ascends the injected extremity. It may be accompanied by a paucity of visualized draining lymph nodes. If an epidermal or subdermal injection is suspected, the exam should be repeated. Whereas conventional lymphangiography better demonstrates lymph vessel morphology, lymphoscintigraphy can readily demonstrate the presence of lymphedema, the location of major nodal groups, and lymphatic drainage patterns at a lower price and with less toxicity and radiation exposure to the patient.