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Intradermal-Stress-Lymphoscintigraphy in Early Detection and Clinical Management of Secondary Lymphedema

A Pictorial Essay

Tartaglione, Girolamo MD*; Visconti, Giuseppe MD; Bartoletti, Roberto MD; Gentileschi, Stefano MD; Ieria, Francesco Pio MD*; Colletti, Patrick M. MD§; Rubello, Domenico MD; Salgarello, Marzia MD

doi: 10.1097/RLU.0000000000002560
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Stress-lymphoscintigraphy evaluates the effects of exercise on lymph drainage. Results may predict outcomes of complex physical therapy as a first-line lymphedema treatment. Microsurgical approaches are best in patients with lymphangectasia or dermal backflow. Lymphatic pathway mapping helps plan lympho-venous anastomoses. For improved lymphatic visualization, we suggest a scan at rest, after a quick exercise (stepping or weight lifting for 2 min) and delayed scanning after prolonged symptom limited exercise (walking or hand squeezing for 30–40 min). In advanced lymphedema, identification of lymph pathways and residual regional lymph nodes might be difficult. In these patients, lymph node transplant is suggested.

From the *Nuclear Medicine, Cristo Re Hospital, Rome

Centre for Surgical Treatment of Lymphedema, Plastic Surgery Department, Agostino Gemelli Hospital, Cattolica del Sacro Cuore University, Rome

Oncological and Phlebolymphological Rehabilitation Service Luigi Maria Monti Foundation, IDI-IRCCS, Rome, Italy

§Department of Radiology, University of Southern California, Los Angeles, CA

Department of Nuclear Medicine, Radiology and Clinical Pathology, Rovigo Hospital, Rovigo, Italy.

Received for publication February 7, 2019; revision accepted February 11, 2019.

Conflicts of interest and sources of funding: none declared.

Correspondence to: Domenico Rubello, MD, Nuclear Medicine, PET Unit S. Maria della Siricordia Rovigo Hospital, Istituto Oncologico Regionale (IOV) Rovigo, Veneto, Italy. E-mail:

Online date: April 15, 2019

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