title: Autonomic regulation of lymphatic flow in the lower extremity demonstrated on lymphoscintigraphy in patients with reflex sympathetic dystrophy.
abstract: OBJECTIVE
  Nuclear medicine techniques were used to show that the peripheral lymphatics are under autonomic control in much the same way as the blood vessels that supply the same anatomic region.
  
  
  METHODS
  Three patients with complex regional pain syndrome type 1 (reflex sympathetic dystrophy) involving a lower extremity were evaluated using three-phase bone scintigraphy and peripheral lymphoscintigraphy. Each patient was treated with ipsilateral chemical lumbar sympathectomy, and lymphoscintigraphy was repeated within several days of the procedure.
  
  
  RESULTS
  All three patients had evidence of decreased flow (compared with the contralateral extremity) to normal flow after ipsilateral sympathectomy. Bone scintigraphy, before and after sympathectomy, was difficult to interpret because of the effects of altered weight bearing. Two patients who had unilateral peripheral edema showed marked improvement after sympathectomy and increased lymphatic flow.
  
  
  CONCLUSIONS
  Peripheral lymphatic function is controlled by the autonomic nervous system. In reflex sympathetic dystrophy, peripheral edema may be caused by an increased sympathetic stimulus to the lymphatics. Further study of this phenomenon may show that nuclear medicine studies, such as bone scintigraphy and lymphoscintigraphy, can be used to distinguish patients who will benefit from sympathectomy from those who will not, thereby obviating invasive testing and unnecessary invasive treatment.
authors.affiliation: Department of Nuclear Medicine, John Hunter Hospital, New South Wales, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Howarth
authors.forename: R
authors.initials: R
authors.lastname: Burstal
authors.forename: C
authors.initials: C
authors.lastname: Hayes
authors.forename: L
authors.initials: L
authors.lastname: Lan
authors.forename: G
authors.initials: G
authors.lastname: Lantry
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007866:Leg; D008196:Lymph / Q000502:physiology*; D008208:Lymphatic System / Q000294:innervation* / Q000503:physiopathology; D008209:Lymphedema / Q000209:etiology; D061305:Lymphoscintigraphy; D008297:Male; D009407:Nerve Block; D012019:Reflex Sympathetic Dystrophy / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012881:Skin Temperature