title: Lymphatic dysfunction in the apparently clinically normal contralateral limbs of patients with unilateral lower limb swelling.
abstract: OBJECTIVE
  To determine how often lymphatic dysfunction is bilateral when, clinically, lymphedema appears unilateral.
  
  
  METHODS
  Lymphoscintigraphy was performed after subcutaneous Tc-99m-nanocolloid injection in the first webspaces of both feet. The percentage of injected radioactivity accumulating in the ilioinguinal regions was recorded in dedicated images separately acquired at 60 and 180 minutes after injection.
  
  
  RESULTS
  Within a consecutive series of 204 patients, 74 had unilateral clinical lymphedema of whom 68 had abnormal scintigraphy. Of these 68 patients, 46 had unilateral abnormal scintigraphy affecting the clinically abnormal limb, but 20 patients had bilateral abnormal scintigraphy and 2 had unilateral abnormal scintigraphy in the clinically unaffected limb. Thus, 32% (22/68) of patients in whom clinical lymphedema appeared to be unilateral, nevertheless, had abnormal scintigraphy in the clinically normal limb. Twenty-nine patients had no clinical evidence of lymphedema in either limb and were scintigraphically normal bilaterally. Mean ilioinguinal nodal accumulation at 180 minutes in the 44 limbs of 22 of these clinically and scintigraphically normal patients (dedicated ilioinguinal imaging was not performed in all patients) was 13.1% (standard deviation, 8.8%), higher (P = 0.02) than the mean value of 9.3% (standard deviation, 5.0%) in the clinically and scintigraphically normal contralateral limbs of 39 patients with unilateral clinical lymphedema.
  
  
  CONCLUSIONS
  In the presence of unilateral lymphedema, the contralateral limb is often also abnormal. On lymphoscintigraphy, therefore, care should be taken before diagnosing unilateral lymphatic dysfunction. Quantification should be included in routine lymphoscintigraphy, as reduced ilioinguinal nodal accumulation may be the only apparent abnormality.
authors.affiliation: Department of Nuclear Medicine, Royal Sussex County Hospital, Brighton, United Kingdom.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Burnand
authors.forename: Daphne M
authors.initials: DM
authors.lastname: Glass
authors.forename: Peter S
authors.initials: PS
authors.lastname: Mortimer
authors.forename: Adrien Michael
authors.initials: AM
authors.lastname: Peters
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000000981:diagnostic imaging*; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008209:Lymphedema / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011877:Radionuclide Imaging; D018570:Risk Assessment; D006113:United Kingdom / Q000453:epidemiology