Lymphatic Dysfunction Detected by Multi-lymphosome Indocyanine Green Lymphography and Lymphatic Ultrasound

Abstract

Summary: Investigation into the cause of lower extremity edema is essential for successful treatment; however, it is sometimes difficult to diagnose. In this case report, we present a patient with bilateral lower extremity edema in whom abnormalities were detected with multi-lymphosome indocyanine green (ICG) lymphography and lymphatic ultrasound. An 87-year-old woman underwent total hysterectomy and pelvic lymphadenectomy for uterine cancer when she was 55 years old. Ten years ago, she was prescribed with a diuretic agent for bilateral edema of the lower extremities; however, the edema did not subside. Conventional general examination, including blood tests, electrocardiography, echocardiography, duplex ultrasound for the legs, and lymphoscintigraphy, did not show any significant abnormalities that may occur with lower limb edema. We performed multi-lymphosome ICG lymphography by injecting ICG in the first web space of the foot, the lateral ankle, and the lateral thigh. This helped us detect lymphatic dysfunction in both lower extremities. Additionally, we performed lymphatic ultrasound and found dilated lymphatic vessels in both lower limbs, indicating lymphatic accumulation within these vessels. Injecting ICG into multiple lymphosomes appears to be useful in diagnosing the causes of lower extremity edema as well as evaluating the lymphatic function of those lymphosomes. Furthermore, lymphatic ultrasound can be used to scan the whole lower extremity because it does not rely on the flow of a contrast agent to produce an image. We believe that combining these diagnostic examinations will make it possible to diagnose patients who have previously been misdiagnosed due to insufficient screening measures.