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Fig. 4 | European Radiology Experimental

Fig. 4

From: Percutaneous afferent lymphatic vessel sclerotherapy for postoperative lymphatic leakage after previous ineffective therapeutic transpedal lymphangiography

Fig. 4

Images from a patient who underwent a melanoma resection on the left leg 4 months before. a A suspicious relapse of one left inguinal lymph node (white arrowhead). Then, a left inguinal lymphadenectomy was performed, and the pathological result confirmed the lymph node metastasis. After this surgery, the continuous LL was observed with an average output of 100 mL/day. Owing to the ineffective surgical revision, the TL was performed and definite iodinated oil extravasation (white arrowheads) from one lymphatic vessel (white arrows) was found using both fluoroscopy (b) and a sequential CT scan, obtaining coronal (c) and axial (d) reconstructions. Ten days after TL, percutaneous ALVS was performed due to there being no regression of the drainage. e In the preoperative CT scan, the afferent lymphatic vessel (white arrowhead) could still be identified. f Afterwards, a successful puncture was achieved, and 1 mL of contrast fluid was injected that showed an ideal distribution around the target lymphatic vessel. Then, 1.0 mL 95% ethanol was injected. One day later, the leakage ceased completely, and the drainage was removed. The patient was discharged on the same day. ALVS Afferent lymphatic vessel sclerotherapy, CT Computed tomography, LL Lymphatic leakage; TL Transpedal lymphangiography

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