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Lymphoceles

Definition:

Abnormal collection of lymphatic fluid that can occur following surgery. For example, a pararenal lymphocele is seen in 10 % of renal transplants within one month of surgery. It is best visualized by ultrasound as a low echogenicity collection which may have thickened septa and internal debris. If necessary it can be drained under ultrasound guidance.

Discussion:(1)

The Lymphocyst (Lymphocele) was first described by Mori in 1955 1 . He analysed a large series of radical hysterectomy patients. He called these collections “ Lymphocysts “, a term that was used until the 1970s.

A lymphocele is a lymph-filled space without a distinct epithelial lining 2 . Lymphoceles are commonly seen following surgical procedures in which large amounts of lymphatic tissue are transacted. Once injured, a lymphatic vessel is quite susceptible to continued leakage. Lymph contains a low concentration of clotting factors and has no platelets. Lymphatic vessels are devoid of smooth muscle and therefore lack any constrictive properties 3 .

A Lymphocele following a blunt injury to thigh is an extremely rare entity. Only three cases have been reported in literature. The first case presented after 12 hrs of application of lower limb tourniquet for knee arthroscopy 4 . Germon published a case following pelvic fracture with crush injury which presented with swelling after a year 5 . Chaloner's patient had lymphocele following blunt war injury. His patient had received a blow from a rifle butt and presented with swelling in the thigh after about 10 weeks of trauma 6 .

The diagnosis of lymphocele is straightforward once the differential has been considered. A computed tomography (CT) scan or an ultrasound examination of the area of interest will confirm the presence and location of fluid collection.

Lymphoceles generally appear cystic but internal echoes and septations may present. Any such collections should be aspirated under radiographic guidance. The fluid should be checked for creatinine, protein, cholesterol, Triglycerides, cell count, Gram stain and culture.

Possible preventive techniques such as placing a drain during transplantation is discussed in the following articles

Treatment discussed includes ultrasound-guided percutaneous drainage, percutaneous catheter drainage, intraperitoneal Tenckhoff catheter,  instillation of diluted povidone iodine is discussed in the following articles.

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Characteristic imaging findings in lymphoceles of the head and neck.

Dec 2011

Hamilton BE, Nesbit GM, Gross N, Andersen P, Sauer D, Harnsberger HR.

Source

Department of Radiology, Oregon Health & Science University, Mail Code CR 135, 3181 SW Sam Jackson Park Rd, Portland, OR 97239.

Abstract

OBJECTIVE:

Lymphoceles are benign neck cysts that are important to differentiate from congenital, infectious, and malignant cystic neck masses because they require unique surgical treatment and follow-up. We reviewed a series of surgically proven lymphoceles to delineate the radiologic characteristics of lymphoceles that differentiate them from other cystic neck masses.

MATERIALS AND METHODS:

A search of radiology report impressions for the terms "lymphocele" and "lymphatic cyst" was performed on all neck CT, MRI, and sclerotherapy studies from January 2003 to December 2009 at our institution. Clinical and pathology records were searched for the same terms to identify additional cases. Medical records confirmed diagnosis. Study images were reviewed on PACS to assess cyst location and imaging characteristics.

RESULTS:

There were nine patients (six women and three men; age range, 22-85 years; mean age, 50.1 years) with 12 pathologically proven lymphoceles on six contrast-enhanced CT and three contrast-enhanced MRI examinations. Lymphoceles were located in the posterior cervical space in 12 of 12 and supraclavicular in 10 of 12 cases. Lymphoceles were unilocular nonseptated cysts in 12 of 12, fluid density or signal in 11 of 12, nonenhancing in 12 of 12, and lacked a cyst wall in eight of 12.

CONCLUSION:

Lymphoceles are rare unilocular cystic neck masses that may mimic other congenital, infectious, and malignant neck cysts. When enhanced CT or MRI shows a unilocular, nonseptated, fluid density or intensity, and nonenhancing supraclavicular cyst in the posterior cervical space, lymphocele is an important part of the differential diagnosis. Atypical features warrant fine-needle aspiration or follow-up for confirmation.

http://www.ncbi.nlm.nih.gov/pubmed/22109299

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Prevention of lymphocele in female pelvic lymphadenectomy by a collagen patch coated with the human coagulation factors: A pilot study.

Oct 2011

Tinelli A, Giorda G, Manca C, Pellegrino M, Prudenzano R, Guido M, Dell'edera D, Malvasi A.

Source

Division of Experimental Endoscopic Surgery, Imaging, Minimally Invasive Therapy & Technology, Department of Obstetrics and Gynaecology, Vito Fazzi Hospital, Lecce, Italy. andreatinelli@gmail.com.

Abstract

BACKGROUND AND OBJECTIVES:

The prevention of lymphoceles was tested using collagen patch coated with the human coagulation factors (TachoSil) on 58 consecutive patients with endometrial cancer who had undergone hysterectomy and pelvic lymphadenectomy (PL).

METHODS:

Patients were randomized in two groups: standard technique plus TachoSil (30 patients, group 1) and standard technique only (28, group 2). All surgical parameters were collected and patients underwent ultrasound examination on postoperative days 7, 14, and 28. The main outcome measures were: the development of symptomatic or asymptomatic lymphoceles, the need for further surgical intervention, as adverse effect of surgery and the drainage volume and duration.

RESULTS:

Same number of lymph nodes in both groups was removed; group 1 showed a lower drainage volume. Lymphoceles developed in 7 patients in group 1 and 16 in group 2, but only 3 were symptomatic in group 1 and 9 symptomatic in group 2, with statistical difference. Percutaneous drainage proved necessary in five cases: only one was in group 1 and four in group 2.

CONCLUSIONS:

Intraoperative application of TachoSil reduced rate of postoperative lymphocysts after PL, and it seems to provide a useful additional treatment option for reducing drainage volume and preventing lymphocele development after PL. J. 

http://onlinelibrary.wiley.com/doi/10.1002/jso.22110/abstract

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Giant lymphocele arising after extraperitoneal laparoscopic radical prostatectomy

Hinyokika Kiyo. 2008 Jan

Mikami H, Ito K, Yoshii H, Kosaka T, Miyajima A, Kaji T, Asano T, Hayakawa M.

Department of Urology, National Defense Medical College.

A 68-year-old male visited our division with an elevation of PSA level. He underwent a needle biopsy of the prostate, and the histopathological diagnosis was poorly differentiated adenocarcinoma (Gleason score 4+3). The cancer was clinically diagnosed as T2aN0M0, and he underwent extraperitoneal laparoscopic radical prostatectomy and bilateral pelvic lymphadenectomy. Cystography 14 days after the operation still showed leakage at the vesico-urethral anastomosis and a dumbbell shaped bladder. A few days later, prominence of lower abdomen and a slight swelling of right leg presented with a high fever. Computed tomography revealed a giant lymphocele in the retroperitoneal space. We percutaneously punctured the lymphocele by using ultrasonography, inserted a pigtail catheter, and drained 1,000 ml of lymphatic fluid. After the puncture, sclerotherapy with minocycline was performed four times. Twenty days after the puncture, the lymphocele cavity was found to have shrunken and the pigtail catheter was removed. The lymphocele was diminished and did not recur thereafter.

PubMed

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Intraoperative placing of drains decreases the incidence of lymphocele and deep vein thrombosis after renal transplantation

BJU Int. 2008 Jan

Derweesh IH, Ismail HR, Goldfarb DA, Araki M, Zhou L, Modlin C, Krishnamurthi V, Flechner SM, Novick AC.

Section of Renal Transplantation, Glickman Urological Institute, and Department and Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, OH, USA.

OBJECTIVE To investigate the effect of placing a prophylactic drain during renal transplantation on the incidence of lymphocele, wound complication and deep venous thrombosis (DVT) in renal transplant recipients induced with sirolimus vs calcineurin inhibitors (CNI), as sirolimus-based immunosuppression is a risk factor for the formation of fluid collections after transplantation. 

PATIENTS AND METHODS We analysed 165 consecutive adult renal transplant patients at our institution between January 2004 and February 2005. Group 1 (84) did not receive an intraoperative drain and group 2 (81) did. Recipients were analysed within each group based on immunosuppression (sirolimus or CNI) and whether they had wound complication, fluid collection, lymphocele treatment, or DVT. 

RESULTS In group 1 and 2, respectively, the wound complication rate was 22.6% vs 13.6% (P = 0.134), the fluid collection rate 45.2% vs 16.% (P < 0.001), the lymphocele treatment rate 19.0% vs 2.5% (P = 0.001) the DVT rate 14.3% vs 4.9% (P = 0.043) the fluid collection rate (for CNI) 26.5% vs 16.0% (P = 0.246), the lymphocele treatment rate (for CNI) 5.9% vs 0% (P = 0.084), the fluid collection rate (sirolimus) 58.0% vs 16.1% (P < 0.001) and lymphocele treatment rate (sirolimus) 28% vs 6.5% (P = 0.018). Multivariate analysis of risk factors for fluid collection showed significance for no drain (odds ratio 3.30, P = 0.002), associated wound complication (2.41, P = 0.041) and sirolimus (2.48, P = 0.015).

 CONCLUSIONS Placing a drain during transplantation decreased the incidence of fluid collection, lymphocele treatment and DVT. The reduction of fluid collection and lymphocele were significant for patients treated with sirolimus. We recommend placing a drain in patients undergoing induction with sirolimus-based immunosuppression.

PubMed

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Late aortic lymphocele and residual ovary syndrome after gynecological surgery

World J Surg Oncol. 2007 Dec

Pastore M, Manci N, Marchetti C, Esposito F, Iuliano M, Manganaro L, Panici PB.

Dept of Obstetrics and Gynecology, "La Sapienza" University, Rome, Italy. natalina.manci@uniroma1.it.

ABSTRACT: BACKGROUND: Gynecological surgery, as radical hysterectomy or pelvic and aortic lymphadenectomy, accounts for more than 50% of iatrogenic injuries. In premenopausal women, an hysterectomy with ovarian sparing and concomitant lateral ovarian transposition is frequently performed. However, the fate of the retained ovary is complicated by the residual ovarian syndrome (ROS) and one of the most common postoperative complications of the lymphadenectomy procedure is the lymphocele, with an average incidence of 22-48.5%. The differential diagnosis of a postoperative fluid collection includes, in addition to a lymphocele, urinoma, hematoma, seroma or abscess and the computed tomography (CT) findings alone is not enough. 

CASE PRESENTATION: We describe a patient, affected by ROS concomitant with a asymptomatic lymphocele, initially confused with an aortic lymph nodes relapse, after abdominal radical hysterectomy. The patient was subjected to a surgical approach, included a diagnostic open laparoscopy and laparotomy with sovraombelico-pubic incision, wide opening of the pelvic peritoneum and retroperitoneum. Examination of the mass revealed, macroscopically, a ovary with multiloculated cystic masses filled with clear or yellow serous fluid and the layers were composed by flat or cuboidal mesothelial cells. 

CONCLUSION: The tribute of this case illustrates the atypical appearance with uncertain aetiology after complex imaging. Gynecologist and radiologist should acquaint with the appearance of fluid collection (urinoma, lymphocele, seroma, hematoma, abscess) in gynecologic oncology follow-up to properly differentiated from tumor recurrence.

World Journal of Surgical Oncology

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Lymphocele after kidney transplantation

Transplant Proc. 2007 Nov

Zietek Z, Sulikowski T, Tejchman K, Sieńko J, Janeczek M, Iwan-Zietek I, Kedzierska K, Rość D, Ciechanowski K, Ostrowski M.

Department of the General Surgery and Transplantology, Pomerenian Medical Academy, Szczecin, Poland. zzietek@poczta.onet.pl

BACKGROUND: One of the most often occurring complications after a kidney transplantation is a lymphocele. 

MATERIALS: The examined group consisted of 118 patients (70 males and 48 females) with end-stage renal disease (ESRD). 

RESULTS: Fourteen patients (12%) developed symptoms of lymphocele within an average time of 34 weeks. The clinical symptoms included the following: decreased 24-hour urine collection and increased creatinine level, abdominal discomfort, lymphorrhoea with surgical wound dehiscence, urgency, vesical tenesmus, and/or fever. Increased appearance of lymphocele was noticed in patients with diabetic nephropathy, congenital malformations of the urinary tract, and inflammatory diseases, including glomerulopathy and extraglomerular ones, after high-voltage radiotherapy and after removal of the renal graft. The methods of treatment and their efficacy were as follows: percutaneous aspiration with the ratio of recurrence 100%; ultrasound guided percutaneous drainage 50%; laparoscopic intraabdominal marsupialization 75%; and surgical intervention with favorable results. 

CONCLUSIONS: Ultrasound-guided percutaneous drainage with a success rate greater than 50% should be recommended as the first line of treatment. As a minimal invasive surgery this kind of treatment does not interfere with subsequent internal drainage through an open or a laparoscopic surgery. Laparoscopy, a feasible, safe technique with a success rate of more than 80%, should be used routinely after unsuccessful percutaneous drainage.

Elsevier

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Did volume of lymphocele after kidney transplantation determine the choice of treatment modality?

Transplant Proc. 2007 Nov

Introduction

Lymphocele is a lymph collection that forms after surgery following injury to lymph nodes and vessels. The aim of the study was to perform a retrospective analysis of different treatment modalities of lymphocele in patients after kidney transplantation.

Material and Methods

A lymphocele located in renal graft area was observed in 25 of 386 transplanted patients (6.5%). Mean patient age was 45 (95% confidence interval [CI], 40 to 50) years. Mean observation time was 35 (95% CI, 27 to 43) months.

Results

Mean time from transplantation to diagnosis of lymphocele was 29 days (range, 4 to 127). In 13 patients (54.2%), the lymphocele was symptomatic, requiring initial treatment by repeated needle aspirations or percutaneous drainage. Among 7 patients with persistence of the lesion treatment by sclerotherapy with doxycycline, povidone-iodine, and/or ethanol was successful in 4 cases who showed maximal lymphocele volume of 500 mL. Three other patients, namely, volumes of 120, 874, and 2298 mL were referred for surgery; in two cases, internal marsupialization was performed and in one case external drainage was necessary due to abscess formation. Mean time from the diagnosis to recovery in patients requiring surgical treatment was 15 (range, 8 to 24) weeks. Eleven patients with asymptomatic lymphoceles (mean volume 45 mL; range, 8 to 140) were monitored to resolution after a mean of 4 (range, 1 to 11) weeks.

Conclusion

All lymphoceles with the maximal volume exceeding 140 mL were clinically symptomatic. Initial percutaneous drainage with or without sclerotherapy was an effective method of treatment. Punctures, drainage, and sclerotherapy were not effective in patients with lymphoceles (>500 mL).

Elsevier

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Instillation of povidone iodine to treat lymphocele and leak of lymph after renal transplantation

Saudi J Kidney Dis Transpl. 2007 Nov;

Zomorrodi A, Buhluli A.

Imam Teaching Hospital, Tabriz, Iran. dr_zomorrodi@yahoo.com

Lymphoceles are common surgical complications of renal transplantation. Recently minimal invasive therapy has been advised. We studied the safety and efficacy of instillation of povidone iodine via transcutaneous catheter for treatment of lymphoceles and leaks of lymph. We studied 10 (four males, six females) kidney transplant recipients who developed lymphoceles after transplantation and four (three males, one female) who developed leaks of lymph. We treated these cases by povidone iodine after placement of transcutaneous catheters with guidance of ultrasound and confirmed the presence of lymph by biochemical analysis. After dilution of povidone iodine to 5% with normal saline, 20cc were instilled and dwelled in the cavity for 30 minute three times daily. The lymph was then allowed to drain by gravity. For the leaks of lymph, which occurred immediately post operation, the catheters were placed during transplantation surgery. All patients were followed up for four months. After one week of instillation, all lymph leaks were completely blocked. Furthermore, nine (90%) cases of lymphocele resolved after 15 days of therapy. We conclude that instillation of diluted povidone iodine for treatment of lymphocele and leak of lymph is safe and effective and it may be considered as first choice for these conditions.

PubMed

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Treatment of recurrent symptomatic lymphocele after kidney transplantation with intraperitoneal Tenckhoff catheter.

Urology. 2007 Oct

Adani GL, Baccarani U, Risaliti A, Gasparini D, Sponza M, Montanaro D, Tulissi P, De Anna D, Bresadola V.

Department of Surgery and Transplantation, Udine University School of Medicine, Udine, Italy. adanigl@hotmail.com

OBJECTIVES: The incidence of lymphocele after kidney transplantation ranges from 0.6% to 16%. The management of lymphocele is still controversial. Percutaneous needle aspiration and external drainage, with or without the injection of sclerosing solutions, are associated with high recurrence and complication rates. Open or laparoscopic intraperitoneal marsupialization requires hospital admission, general anesthesia, and, sometimes, extensive surgical dissection. 

METHODS: We report our experience treating recurrent symptomatic lymphocele with intraperitoneal drainage using a Tenckhoff catheter on an outpatient basis in 7 consecutive patients. In all cases, the lymphocele was diagnosed by abdominal ultrasonography 26 to 90 days after kidney transplantation. The mean diameter of the lymphocele was 14 +/- 6 cm. Percutaneous drainage was the initial approach, which was also used to differentiate between urinoma and lymphocele and to rule out infection. The lymphocele recurred within 1 month in all cases. The recurrent lymphoceles were treated on an outpatient basis using intraperitoneal drainage with a Tenckhoff catheter inserted into the lymphocele under ultrasound guidance. After administration of local anesthesia, two 1-cm vertical incisions were performed: one to access the lymphocele and the other to access the peritoneal cavity. A Tenckhoff catheter was inserted in the lymphocele and tunneled into the peritoneal cavity. 

RESULTS: All procedures were completed on an outpatient basis without any complications. The catheter was removed 6 months later with no evidence of recurrent lymphocele at ultrasound follow-up in all cases. 

CONCLUSIONS: This outpatient surgical approach using ultrasound-guided intraperitoneal drainage with a Tenckhoff catheter appears to be a simple, effective, and safe method for treating unilobular recurrent symptomatic lymphocele after renal transplantation.

Elsevier

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Percutaneous transcatheter ethanol sclerotherapy and catheter drainage of postoperative pelvic lymphoceles.

Cardiovasc Intervent Radiol. 2007 Mar-Apr

Akhan O, Karcaaltincaba M, Ozmen MN, Akinci D, Karcaaltincaba D, Ayhan A.

Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey.

The aim of this study is to investigate the efficacy and long-term results of percutaneous transcatheter ethanol sclerotherapy (PTES) for postoperative pelvic lymphocele treatment. Fifty-two patients who were referred for lymphocele treatment were included in this study. Sixty lymphoceles of 52 patients were treated by percutaneous treatment with or without ethanol sclerotherapy. Lymphoceles developed in 47 and 5 patients, who underwent gynecologic malignancy operation (31 ovarian cancer, 6 cervix cancer, 10 endometrial cancer) and renal transplantation, respectively. Lymphoceles were catheterized by ultrasonography and fluoroscopy guidance using the Seldinger technique. Lymphoceles smaller than 150 mL underwent single-session ethanol sclerotherapy and the others were treated by multiple-session ethanol sclerotherapy. In 10 patients, percutaneous ethanol sclerotherapy could not be performed and they were treated only by percutaneous catheter drainage. The mean lymphocele volume was 329 mL (15-2900 mL). The mean catheterization duration was 11.8 days (1-60 days). The mean follow up time was 25.8 months (2-64 months). The initial treatment was successful in 46 out of 50 (91%) lymphoceles treated with PTES and 7 out of 10 (70%) lymphoceles treated with percutaneous catheter drainage. Minor complications (secondary infection and catheter dislodgement) were noted in seven (11.6%) patients. Recurrence developed in four and three patients who were treated by PTES and percutaneous catheter drainage, respectively. Five of these patients were treated with PTES without further recurrence. Percutaneous transcatheter ethanol sclerotherapy is an effective and reliable method for the treatment of postoperative lymphoceles.

Springerlink

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Pelvic lymphocele following radical para-aortic and pelvic lymphadenectomy for cervical carcinoma: incidence rate and percutaneous management

M Conte, PB Panici, L Guariglia, G Scambia, S Greggi, and S Mancuso

Thirty-six women, treated with radical hysterectomy (Piver types III-IV) plus systematic para-aortic and pelvic lymphadenectomy for cervical carcinoma, underwent serial postoperative ultrasound examinations to determine the incidence of lymphocele and the therapeutic efficacy of percutaneous catheter drainage. Pelvic lymphoceles, ranging in volume from 46-300 mL, occurred in eight patients (22.2%) between the 12-24th postoperative day. Percutaneous catheter drainage, inserted under local anesthesia, was used for a mean time of 14.5 days (range 4-32), resulting in a mean daily drainage of 92.2 mL and a mean total volume of 1727.5 mL per patient. Catheter drainage allowed complete clinical and sonographic remission in all cases, and only one asymptomatic recurrence was observed at 3-month and 6-month follow-up. Ultrasound-guided percutaneous catheter drainage has proved to be a well-tolerated, safe, and effective technique in the management of lymphocele that obviates the need for more invasive surgical procedures.

http://www.ncbi.nlm.nih.gov/pubmed/2196500

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Breast lymphocele

Rakhtawane E, Chedid G, Benismaili M, Khoury R, Le Van An J.C.

Service de radiologie, Centre hospitalier Robert Ballanger, Bd Robert Ballanger, 93600 Aulnay sous bois 
FRANCE
Patient
Age: 65 year(s)
Sex: F

Clinical History and Imaging

The patient underwent an axillary lymph node dissection for lymph node metastases. Pathology revealed carcinoma but no breast tumor was found. 4 months later a cystic mass was felt.
A mammography and MRI was performed to search for a breast tumor, but showed a large cystic mass.
A control ultrasound was performed 3 months later.

Discussion

Lymphocele is a lymphatic collection in the detachment spaces created by the ablation of lymphatic tissue from the drainage surface of a malignant tumour. It constitutes the most important complication of lymphadenectomy. The formation of this lymphocele is often in connection with the secondary appearance of a chronic lymphedema.

The incidence has been reported to range from 5% to 35% according to Salmon, and 12% according to Salvat.
Physical examination in seated or upright position is necessary to reveal the swelling, which may remain unsuspected. To detect a small lymphocele, ultrasound is useful within one week after surgery. According to Salmon there is a positive correlation between the incidence of the lymphocele and the quantity of drained fluid, the duration of drainage and the extent of the lymph nodes dissection area, the age of the patient, obesity, arterial hypertension and breast volume. The impact of an anticoagulant treatment by heparine has been reported. According to Flew the volume and duration of the lymphocele are decreased when the patient has no early physiotherapeutic shoulder treatment after surgery. The external postoperative radiotherapy and the tumor staging do not affect the formation of lymphocele. No treatment is recommended when the lymphoceles are quiet or less than 2 cm . For those larger or which are under tension, percutaneous aspiration, or percutaneous drainage should be performed . Spontaneous regression may be up to 15% within several months. Preventive treatment is more effective, Aitken suggested a reduction of the surgical detachment spaces as a real solution to decrease seriously the incidence.

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Postoperative Pelvic Lymphocele: Treatment with Simple Percutaneous Catheter Drainage 1

Jae-Kyu Kim, MD, Yong-Yeon Jeong, MD, Yun-Hyeon Kim, MD, Young-Chul Kim, MD, Heoung-Keun Kang, MD and Ho-Sun Choi, MD

1 From the Departments of Diagnostic Radiology (J.K.K., Y.Y.J., Y.H.K., Y.C.K., H.K.K.) and Obstetrics and Gynecology (H.S.C.), Chonnam University Medical School, 8 Hakdong, Dongku, Kwangju, 501-757 South Korea. Received May 18, 1998; revision requested July 14; revision received September 9; accepted February 12, 1999. Address reprint requests to J.K.K. (e-mail: kjkrad@chonnam.chonnam.ac.kr).

Abstract

PURPOSE: To evaluate the effectiveness of simple percutaneous catheter drainage in the treatment of postoperative lymphocele.

MATERIALS AND METHODS: Percutaneous catheter drainage of 23 symptomatic lymphoceles was performed with ultrasonographic (US) guidance in 20 patients who had undergone radical pelvic lymphadenectomy because of uterine malignancy. All lymphoceles were diagnosed on the basis of biochemical and cytologic findings in aspirated fluid. The drainage catheter was removed when the amount of daily drainage was less than 10 mL per day and when the lymphocele was seen at imaging to have resolved. Follow-up US was performed at 1, 3, and 6 months after catheter removal. The results were classified as success, partial success, or failure.

RESULTS: Lymphoceles ranged in size from 5 x 4 x 3 to 25 x 10 x 10 cm. Mean total drainage volume was 2,012 mL (range, 300–17,240 mL). Fluid from 10 lymphoceles (43%) was positive at Gram staining and bacteriologic culture; fluid from 13 (57%) was sterile. Duration of catheter drainage was 3–49 days (mean, 22 days). Twenty (87%) lymphoceles resolved completely; three (13%) recurred. Two recurrent lymphoceles were again treated with percutaneous catheter drainage; the third resolved spontaneously 5 months after catheter removal. Successful treatment was ultimately achieved in all patients. Postprocedural complications occurred in four patients. One had a secondary infection of lymphocele; one, catheter dislodgment; and two, skin infection at the site of catheter insertion.

CONCLUSION: Percutaneous catheter drainage is safe and effective for treatment of symptomatic postoperative lymphoceles.

Index terms: Cyst, percutaneous drainage, 992.1263 • Lymphatic system, interventional procedure, 992.123, 992.1263 • Lymphocele, 992.842

Complete article:

http://radiology.rsnajnls.org/cgi/content/full/212/2/390

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Mediastinal lymphocele following radical esophagogastrectomy

Int Urol Nephrol. 2008 Mar 28

Khan MS, Ahmed S, Challacombe B, Goldsmith D, Steward M.

(1)  Departments of Urology and Nephrology & Renal Transplantation, Guy’s & St Thomas’ Hospital, London, SE1 9RT, UK
(2)  Department of Urology, Guy’s Hospital, 1st Floor Thomas Guy’s House, London, SE1 9RT, UK
(3)  Department of Radiology, Royal Free Hospital, London, NW3 2QG, UK

Departments of Urology and Nephrology & Renal Transplantation, Guy’s & St Thomas’ Hospital, London, SE1 9RT, UK, shamim.khan@gstt.sthames.nhs.uk.

We report a case of post-transplantation lymphoproliferative disorder presenting as a symptomatic lymphocele 12 years after cadaveric renal transplantation for IgA nephropathy. The presentation, imaging, and management are discussed. We review current literature concerning PTLD, post-transplantation lymphoceles, and state-of-the-art imaging techniques.

Keywords:  Immunosuppression - Lymphocele - Malignancy - Post-transplantation lymphoproliferative disorder - Renal transplantation

Springerlink

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Prevention of postoperative lymphocele after breast amputation

Salmon RJ, Cody HS, Vedrenne JB, Asselain B, Durand JC, Pilleron JP.

Closed suction drainage is widely used after modified radical mastectomy to prevent accumulation of serum or lymph and to promote adherence of the skin flaps to the chest wall. However, between 5 and 35% of the patients develop seroma, which may prolong their stay in hospital and require more frequent post-operative outpatient visits. The prospective study reported demonstrate a significant correlation between the incidence of post-operative seromas, the duration of suction drainage and the amounts of fluid drained. The incidence of seroma also correlated significantly with the patient's age, the size of the breast removed, the presence of arterial hypertension and the post-operative use of heparin. Pre-operative radiotherapy and the TNM type of the tumour had no effect on the duration and volume of drainage nor on the occurrence of seromas. A drainage of short duration and a short stay in hospital are advocated for most mastectomy patients. Delayed mobilization of the shoulder should decrease the volume of accumulated fluid and the incidence of seromas.

PMID: 3155841 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed?term=Prevention%20of%20postoperative%20lymphocele%20after%20breast%20amputation

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Laparoscopic Drainage of Lymphocele after Kidney Transplant
 
Journal of Laparoendoscopic & Advanced Surgical Techniques   1 April 2003, vol. 13, no. 2,   pp. 127-129(3)
 
Garay J.M.[1]; Alberú J.[2]; Angulo-Suárez M.[3]; Bezauri-Rivas P.[3]; Herrera M.F.[4]
 
[1] Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico [2] Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico [3] Department of Roentgenology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico [4] Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

Abstract: 

Lymphocele can develop after renal transplantation. Surgical internal drainage to the abdominal cavity through a standard laparotomy is indicated for symptomatic persistent lesions. Internal drainage can be performed laparoscopically. In this report, we describe our laparoscopic surgical technique for drainage and analyze our results in five patients with lymphoceles that developed after kidney transplantation. All the patients were male, with a mean age of 29 ± 10 years. The volume of fluid in the lymphoceles ranged from 500 to 1000 mL. Percutaneous drainage was selected as the initial treatment without success. A laparoscopic peritoneal window was created in all patients under intraoperative ultrasonographic guidance. The mean operative time was 90 minutes. In all patients, the fluid collections resolved after laparoscopic internal drainage without complications. During a mean follow-up of 3 ± 2 years, all patients remained asymptomatic, and no additional fluid collections were identified.
 
Document Type: Case report ISSN: 1092-6429

Ingenta

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The influence of various maintenance immunosuppressive drugs on lymphocele formation and treatment after kidney transplantation.

Goel M, Flechner SM, Zhou L, Mastroianni B, Savas K, Derweesh I, Patel P, Modlin C, Goldfarb D, Novick AC.

Section of Renal Transplantation, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.

PURPOSE: We compared the incidence of lymphocele formation and treatment in kidney transplant recipients given 3 immunosuppressive drug regimens. 

MATERIALS AND METHODS: Consecutive series of adult kidney only recipients, including group 1-152 who received sirolimus/mycophenolate mofetil (MMF)/prednisone (P), group 2-168 who received cyclosporine/MMF/P and group 3-193 who received cyclosporine/azathioprine/P, were analyzed for post-transplantation lymphocele formation. All available records and imaging studies were reviewed, such as ultrasound, computerized tomography, magnetic resonance imaging etc, for peritransplant fluid collections greater than 2.5 cm. Demographic characteristics and the risk factors for lymphocele were compared in these 513 recipients using univariate and multivariate analysis. 

RESULTS: The overall incidence of lymphocele formation was 174 of 513 cases (33.9%) and the incidence of treated lymphoceles was 81 of 513 (15.7%). In groups 1 to 3 the incidence was 45.5%, 33.9% and 24.7%, respectively. These differences were significantly higher in group 1 vs groups 2 or 3 (p = 0.014) but they were not significantly different between groups 2 and 3. Similarly the incidence of treated lymphoceles was 23%, 12.5% and 12.9%, respectively. Findings were again statistically higher in group 1 vs groups 2 and 3 (p = 0.003) but not statistically significant between groups 2 and 3. A greater number of group 1 patients required surgical interventions compared with those in groups 2 and 3 (13.8% vs 4.7% and 4.8%, respectively, p = 0.019). In addition, acute rejection (p = 0.001) and body mass index greater than 32 (p = 0.02) were significant risk factors on multivariate analysis. 

CONCLUSIONS: The combination of sirolimus/MMF/P, obesity with a body mass index of greater than 30 kg/m and acute rejection are independent risk factors for lymphocele formation and treatment after kidney transplantation. Patients should be counseled and consideration should be given to prophylactic measures in this higher risk renal transplant population.

PMID: 15076277 [PubMed - indexed for MEDLINE]

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External Links:

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Fibrinogen and thrombin coated patch use on collagen support for lymphocele prevention after lumbar-aortic lymphadenectomy in gynecological neoplasms. Oct 2011

http://www.minervamedica.it/en/journals/minerva-ginecologica/article.php?cod=R09Y2011N05A0471

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Management of primary symptomatic lymphocele after kidney transplantation: a systematic review. Sept 2011

http://journals.lww.com/transplantjournal/pages/articleviewer.aspx?year=2011&issue=09270&article=00010&type=abstract

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The 'packing of the groin' technique: an innovative approach for groin lymphocele. Oct 2011

http://icvts.ctsnetjournals.org/cgi/content/full/13/4/367

----------------

Lymphocele after renal transplantation, a medical complication. Nov 2011

http://www.ncbi.nlm.nih.gov/pubmed/21748721

----------------

The deep vein thrombosis caused by lymphocele after endoscopic extraperitoneal radical prostatectomy and pelvic lymph node dissection. June 2011

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3125587/?tool=pubmed

----------------

The use of a polymeric sealant for prevention of posttransplantation lymphocele. May 2011

http://www.transplantation-proceedings.org/article/S0041-1345(11)00529-X/abstract

----------------

Mediastinal lymphocele following radical esophagogastrectomy

April 2008

http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/cjs/vol-51/issue-2/pdf/pgE48.pdf

----------------

Intraperitoneal Tenckhoff catheter for the treatment of recurrent lymphoceles after kidney transplantation: our early experience

Transplant Proc. 2007 Jul-Aug

Elsevier

----------------

Lymphocele formation after anterior lumbar interbody fusion at L4-5. Case report.

J Neurosurg Spine. 2007 Nov

PubMed

----------------

Lymphocele and kidney transplantation

Orv Hetil. 2007 Aug

Akademiai Kiado

----------------

Treatment of a recurrent inguinal lymphocele in a penis cancer patient by lymphography and selective ligation of lymphatic vessels.

Int J Urol. 2007 May

Blackwell Synergy

----------------

Traumatic Lymphocele Following Blunt Injury: (1)
A Case Report

http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijra/vol2n2/traumatic.xml

----------------

Anterior thoracic wall traumatic lymphocele: a case report.

Acta Chir Belg. 2007 Jan-Feb

PubMed

----------------

Spontaneous cervical lymphocele.

Head Neck. 2007 Jan

Wiley InterScience

----------------

Does opening the peritoneum at the time of renal transplanation prevent lymphocele formation?

Transplant Proc. 2006 Dec

Elsevier

----------------

Laparoscopic marsupialization of postrenal transplantation lymphoceles

J Endourol. 2006 Nov

Mary Ann Liebert Publishers

----------------

Novel technique to prevent lymphocele recurrence after laparoscopic lymphocele fenestration in renal transplant patients.

J Endourol. 2006 Sep

Mary Ann Liebert Publishers

----------------

Lymphocele following renal transplantation

Saudi J Kidney Dis Transpl. 2006 Mar

PubMed

===========================

Join us as we work for lymphedema patients everywehere:

Advocates for Lymphedema

Dedicated to be an advocacy group for lymphedema patients. Working towards education, legal reform, changing insurance practices, promoting research, reaching for a cure.

http://health.groups.yahoo.com/group/AdvocatesforLymphedema/

Subscribe: AdvocatesforLymphedema-subscribe@yahoogroups.com

Pat O'Connor

Lymphedema People / Advocates for Lymphedema

===========================

For information about Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema\

For Information about Lymphedema Complications

http://www.lymphedemapeople.com/wiki/doku.php?id=complications_of_lymphedema

For Lymphedema Personal Stories

http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=3

For information about How to Treat a Lymphedema Wound

http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound

For information about Lymphedema Treatment 

http://www.lymphedemapeople.com/wiki/doku.php?id=treatment

For information about Exercises for Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema

For information on Infections Associated with Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema

For information on Lymphedema in Children

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children

Lymphedema Glossary

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing

===========================

Lymphedema People - Support Groups

-----------------------------------------------

Children with Lymphedema

The time has come for families, parents, caregivers to have a support group of their own. Support group for parents, families and caregivers of chilren with lymphedema. Sharing information on coping, diagnosis, treatment and prognosis. Sponsored by Lymphedema People.

http://health.groups.yahoo.com/group/childrenwithlymphedema/

Subscribe: childrenwithlymphedema-subscribe@yahoogroups.com

......................

Lipedema Lipodema Lipoedema

No matter how you spell it, this is another very little understood and totally frustrating conditions out there. This will be a support group for those suffering with lipedema/lipodema. A place for information, sharing experiences, exploring treatment options and coping.

Come join, be a part of the family!

http://health.groups.yahoo.com/group/lipedema_lipodema_lipoedema/?yguid=209645515

Subscribe: lipedema_lipodema_lipoedema-subscribe@yahoogroups.com

......................

MEN WITH LYMPHEDEMA

If you are a man with lymphedema; a man with a loved one with lymphedema who you are trying to help and understand come join us and discover what it is to be the master instead of the sufferer of lymphedema.

http://health.groups.yahoo.com/group/menwithlymphedema/

Subscribe: menwithlymphedema-subscribe@yahoogroups.com

......................

All About Lymphangiectasia

Support group for parents, patients, children who suffer from all forms of lymphangiectasia. This condition is caused by dilation of the lymphatics. It can affect the intestinal tract, lungs and other critical body areas.

http://health.groups.yahoo.com/group/allaboutlymphangiectasia/

Subscribe: allaboutlymphangiectasia-subscribe@yahoogroups.com

......................

Lymphatic Disorders Support Group @ Yahoo Groups

While we have a number of support groups for lymphedema... there is nothing out there for other lymphatic disorders. Because we have one of the most comprehensive information sites on all lymphatic disorders, I thought perhaps, it is time that one be offered.

DISCRIPTION

Information and support for rare and unusual disorders affecting the lymph system. Includes lymphangiomas, lymphatic malformations, telangiectasia, hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of information available through sister site Lymphedema People.

http://health.groups.yahoo.com/group/lymphaticdisorders/

Subscribe: lymphaticdisorders-subscribe@yahoogroups.com

===========================

Lymphedema People New Wiki Pages

Have you seen our new “Wiki” pages yet?  Listed below are just a sample of the more than 140 pages now listed in our Wiki section. We are also working on hundred more.  Come and take a stroll! 

Lymphedema Glossary 

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing 

Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema 

Arm Lymphedema  

http://www.lymphedemapeople.com/wiki/doku.php?id=arm_lymphedema 

Leg Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=leg_lymphedema 

Acute Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=acute_lymphedema 

The Lymphedema Diet 

http://www.lymphedemapeople.com/wiki/doku.php?id=the_lymphedema_diet 

Exercises for Lymphedema  

http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema 

Diuretics are not for Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=diuretics_are_not_for_lymphedema 

Lymphedema People Online Support Groups 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_people_online_support_groups 

Lipedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=lipedema 

Treatment 

http://www.lymphedemapeople.com/wiki/doku.php?id=treatment 

Lymphedema and Pain Management 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pain_management 

Manual Lymphatic Drainage (MLD) and Complex Decongestive Therapy (CDT)

http://www.lymphedemapeople.com/wiki/doku.php?id=manual_lymphatic_drainage_mld_complex_decongestive_therapy_cdt 

Infections Associated with Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema 

How to Treat a Lymphedema Wound 

http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound 

Fungal Infections Associated with Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=fungal_infections_associated_with_lymphedema 

Lymphedema in Children 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children 

Lymphoscintigraphy 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphoscintigraphy 

Magnetic Resonance Imaging 

http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging 

Extraperitoneal para-aortic lymph node dissection (EPLND) 

http://www.lymphedemapeople.com/wiki/doku.php?id=extraperitoneal_para-aortic_lymph_node_dissection_eplnd 

Axillary node biopsy 

http://www.lymphedemapeople.com/wiki/doku.php?id=axillary_node_biopsy

Sentinel Node Biopsy 

http://www.lymphedemapeople.com/wiki/doku.php?id=sentinel_node_biopsy

 Small Needle Biopsy - Fine Needle Aspiration 

http://www.lymphedemapeople.com/wiki/doku.php?id=small_needle_biopsy 

Magnetic Resonance Imaging 

http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging 

Lymphedema Gene FOXC2

 http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_foxc2

 Lymphedema Gene VEGFC

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_vegfc

 Lymphedema Gene SOX18

 http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_sox18

 Lymphedema and Pregnancy

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pregnancy

Home page: Lymphedema People

http://www.lymphedemapeople.com

Page Updated: Dec. 5, 2011