Lympho-scintigraphic localisation of obstructions in primary lymphodema of lower limbs in the Central Province of Sri Lanka from 1990 to 2003

Abstract

Introduction: Primary lymphoedema constitutes the bulk of cases among those seeking treatment in the Central province1. The underlying pathophysiological mechanics at presentation have not yet been established in Sri Lanka. Objective: To describe the location of the sites of obstruction to lymphatic flow in primary lymphoedema among Sri Lankan patients related to their clinical level of lymphoedema at presentation. Method: Eighty consecutive patients with primary lymphoedema, with varied levels of clinical lymphoedema were studied by isotope lympho-scintigraphy to ascertain where the block occurred, for each level of clinical lymphoedema of the lower limb. Results: The location of scintigraphic obstruction was always located more proximal in the limb, to the level of clinical lymphoedema. The site varied for each clinical level. Sites were related to the anatomical location of lymph nodes except for, a very common site in the medial knee. Such blocks were associated with rapid entry to the blood stream suggestive of the existence of lympho-venous shunting at this level. In most, the presenting level of lymphoedema was reached within 24-months of onset. Conclusion: Lymph nodes are probably the site of obstruction in most cases of primary lymphoedema. Presenting clinical level of lymphoedema is a dynamic of, site of lymphatic blockage and the presence of lympho-venous shunting.

Keywords

• primary lymphoedema
• lower limbs
• lympho-scintigraphy