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Autonomic Regulation of Lymphatic Flow in the Lower Extremity Demonstrated on Lymphoscintigraphy in Patients With Reflex Sympathetic Dystrophy

HOWARTH, DOUGLAS M.D.*; BURSTAL, RICHARD M.D.; HAYES, CHRIS M.D.; LAN, LINDA R.N.*; LANTRY, GENA R.N.

Original Articles

Purpose: 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.

From the Departments of Nuclear Medicine* and Anaesthetics, John Hunter Hospital, New South Wales, Australia

Received for publication August 6, 1998. Accepted September 23, 1998.

Reprint requests: Dr. D. Howarth, Department of Nuclear Medicine, John Hunter Hospital, Locked Bag no. 1, Newcastle Regional Mail Centre 2310, New South Wales, Australia.

© 1999 Lippincott Williams & Wilkins, Inc.