Research ArticleImaging

Lymphoscintigraphy of Chylous Anomalies: Chylothorax, Chyloperitoneum, Chyluria, and Lymphangiomatosis—15-Year Experience in a Pediatric Setting and Review of the Literature

Sophie Turpin and Raymond Lambert
Journal of Nuclear Medicine Technology June 2018, 46 (2) 123-128; DOI: https://doi.org/10.2967/jnmt.117.203281

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Normal lymphoscintigraphy findings after injection in upper and lower extremities.

  • FIGURE 2.
    FIGURE 2.

    Congenital chylothorax. (A) No abnormal accumulation after injection in both hands: anterior view (top) and posterior view (bottom) of thorax with activity in axillary lymph nodes. (B) Thoracic accumulation of tracer (arrows), including in thoracic canal region, after injection in both feet: anterior view (top) and posterior view (bottom) with visualization of ilioinguinal lymph nodes.

  • FIGURE 3.
    FIGURE 3.

    Gorham disease. (A) Abnormal accumulation of tracer in mediastinum (arrow) after injection in both upper and lower extremities. (B and C) MR images showing diffuse infiltration of mediastinum (arrow) secondary to lymphangiomatosis (B) and presence of loculated chylothorax (arrow) (C).

  • FIGURE 4.
    FIGURE 4.

    Lymphangiomatosis in patient with chylopericardium necessitating drainage. (A and C) Normal findings with standard diet: injection in upper (A) and lower (C) extremities. (E) No activity in collecting bag. (B and D) Left shoulder and right inguinal region showing lymphangiectasia (arrows) on lymphoscintigraphy performed after switching patient to high-fat diet: injection in upper (B) and lower (D) extremities. (F) Activity (arrow) in collecting bag.

  • FIGURE 5.
    FIGURE 5.

    Chyloperitoneum. After injection in the 4 extremities, abnormal accumulation of tracer in abdomen at 1 h on anterior (A) and left lateral (C) views and at 5 h on anterior (B) and left lateral (D) views.

  • FIGURE 6.
    FIGURE 6.

    (A) After injection in the lower extremities, lymphoscintigraphy image at 1 h demonstrating leak (arrow). (B) Diffuse intraabdominal accumulation at 5 h after injection. (C) Conventional lymphography showing dysplastic lymphatics (arrow) and intraabdominal leak.

  • FIGURE 7.
    FIGURE 7.

    Anatomy of lymphatic system. (Adapted from Wikimedia Commons.)

Tables

  • TABLE 1

    Patient Characteristics

    Patient no.AgeSexPresentationFinding
    111 moFChylothorax after cardiac surgeryTN
    24 yMChylothorax after cardiac surgeryTP
    34 moMChylothorax after cardiac surgeryTN
    45 yFChylothorax after cardiac surgeryFN
    51 moFChylothorax after cardiac surgeryFN
    618 yMChylothorax after cardiac surgeryTP or FN
    72 moMChylothorax after cardiac surgeryTP
    81 moMIdiopathic congenital chylothoraxFN
    91 moFIdiopathic congenital chylothoraxTN
    104 yFPseudo chylothoraxTN
    111 moMCongenital chylothorax/gastroschisisTP
    1215 yMChylothorax/lymphangiomatosisTP
    1313 yFChylothorax/lymphangiomatosisFN
    1415 yFChylothorax/lymphangiomatosisSee text
    153 yFChyloperitoneum/lymphangiectasiaTP
    1610 moMChyloperitoneum after cardiac surgeryTP
    1710 moMChyloperitoneum/lymphangiomatosisTP
    189 yFAbdominal lymphangiomatosisTP
    1916 yFExudative enteropathyTN
    2016 yMExudative enteropathyTN
    218 yMChyluriaNA

    • TN = true-negative; TP = true-positive; FN = false-negative; NA = not applicable.

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