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How a lymphoscintigraphy of the lower limbs is performed


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Why perform a lymphoscintigraphy of the lower limbs in the case of lipedema? How is this examination performed? And what is the purpose of the lymphatic system?

How a lymphoscintigraphy of the lower limbs is performed.

What is the lymphatic system?

The lymphatic system is a network of lymphatic vessels that connects tissues to lymphatic organs through which lymph flows. The lymphatic organs are the bone marrow, thymus, lymph nodes, tonsils and spleen. Lymph plays an essential role in the proper functioning of the immune system. If you have lipedema, you will probably need to have an examination of your lymphatic system. This is called a lymphoscintigraphy of the lower limbs.

Why perform a pedal lymphoscintigraphy?

Pedal lymphoscintigraphy (i.e. of the lower limbs) is a functional imaging examination that studies the vessels and lymph nodes. It is requested as part of an assessment of oedema of the lower limbs and is carried out before any surgery. It is complementary to the clinical examination and allows :

  • Knowing whether or not lipedema disease is associated with lymphatic disease.
  • Knowing whether lipedema has already damaged the lymphatic system.
  • Plan in advance for longer rehabilitation for one leg or not.

You should know that the liposuction WAL technique used by Dr. Nicolas Zwillinger in lipoedema surgery never damages the patient’s lymphatic system .

How does the exam work?

The examination is usually carried out in half a day on an outpatient basis. You do not have to fast, you can eat and take your medication normally.

In practice, when you have a lymphoscintigraphy of the lower limbs, the doctor injects a small quantity of tracer product under the skin in the feet. The product is composed of macro aggregates of human serum albumin, labelled with 99m Technetium, derived from blood products. It is not allergenic. A first series of images is taken as soon as the injection is made using a device called a Gamma camera. This first series of images lasts about an hour. You will lie on an examination table under the camera and you must remain very still during the injection and the taking of pictures. These pictures show how the product is transported from the lymphatic channels to the lymph nodes.

You should then walk for an hour to stimulate lymphatic circulation. You need to keep moving.

A second series of images is taken during a short hour following this walk. Depending on the results, a third series may be performed. You will then be seen by the nuclear doctor who will explain the results obtained. The results will be communicated to your doctor and to the surgeon in the case of lipedema surgery.

Pedal lymphoscintigraphy is indicated in the pre-operative assessment of lipedema. It allows the diagnosis of a possible primary lymphedema or on the contrary to exclude it.

Things to remember before your exam

As with any examination, you should bring :

  • Your “carte vitale” and certificate of health insurance.
  • Your doctor’s prescription.

Your previous ultrasound and doppler examinations in particular.

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