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Fig. 5 | European Radiology Experimental

Fig. 5

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

Fig. 5

Images from a patient who underwent a melanoma resection 1 year before. a Contrast-enhanced CT showed a suspicious metastatic lymph node (white arrowheads) at the right proximal thigh. Hence, a right inguinal lymphadenectomy was performed, and the postoperative pathological result confirmed the metastasis of the lymph node. Because of the postoperative LL, the therapeutic TL was performed showing definite iodinated oil extravasation (white arrowhead) from two lymphatic vessels (white arrows) using both fluoroscopy (b) and a CT scan, obtaining coronal (c) and axial (d) reconstructions. Twenty-eight days after TL, percutaneous ALVS was performed owing to the continuous leakage. e The two target afferent lymphatic vessels (white arrows) close to the leakage could still be identified. f During the puncture, the needle tip was located between the two afferent lymphatic vessels, and 1 mL of contrast fluid was injected that showed an ideal distribution covering both the target lymphatic vessels. g After injection of 2.0 mL of 95% ethanol, a CT scan was performed which showed a nebulous dispersal of the contrast completely covering the two target lymphatic vessels. One day later, the leakage ceased and the drainage could be removed. The patient was discharged on the same day. h Around 3 months later, magnetic resonance imaging showed no tumour recurrence and fluid accumulation. A mild enhancement (white arrowheads) at the region of sclerotherapy could be observed which indicated clinically inapparent scarring after ALVS. In the further follow-up for 1 year, no relapse of the tumour or lymphatic leakage was found. ALVS Afferent lymphatic vessel sclerotherapy, CT Computed tomography, LL Lymphatic leakage, TL Transpedal lymphangiography

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