Posttraumatic edema of the lower extremities: Evaluation of the lymphatic vessels with magnetic resonance lymphangiography Christian Lohrmann, MD, Gregor.

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Posttraumatic edema of the lower extremities: Evaluation of the lymphatic vessels with magnetic resonance lymphangiography Christian Lohrmann, MD, Gregor Pache, MD, Gunter Felmerer, MD, Etelka Foeldi, MD, Oliver Schaefer, MD, Mathias Langer, MD Journal of Vascular Surgery Volume 49, Issue 2, Pages 417-423 (February 2009) DOI: 10.1016/j.jvs.2008.08.069 Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

Fig 1 A 75-year-old man with amputed left lower leg due to a bomb explosion in World War II with consecutive development of a lymphedema in the stump of the remaining upper leg. A, Coronal heavily T2-weighted 3D-TSE source image demonstrates epifascial lymphedema of the stump (arrows). B, Frontal 3D spoiled gradient-echo magnetic resonance lymphangiography (MRL) MIP-image, obtained 25 minutes after gadoteridol injection, clearly depicts several enlarged lymphatic vessels up to a diameter of 3 mm (small arrows) at the lever of the left stump originating from the contrast media injection depots (aterisks). Additionally, several enlarged lymphatic vessels are detected at the level of the clinically inconspicuous right lower leg (large arrows). Note the parallel enhancing vein, which shows a lower signal intensity (arrowhead). C, Angled spoiled gradient-echo MRL MIP-image, obtained 25 minutes after gadoteridol injection, reveals several enlarged lymphatic vessels up to a diameter of 3 mm at the level of both knees and upper legs (arrows). Note the parallel enhancing vein at the level of the left upper leg, which shows a lower signal intensity (arrowhead). Early enhanced lymph nodes are demarcated at the level of both inguinal regions (asterisks). Journal of Vascular Surgery 2009 49, 417-423DOI: (10.1016/j.jvs.2008.08.069) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

Fig 2 A 40-year-old woman with unilateral secondary lymphedema of the left lower leg due to direct trauma in a car accident. A, Frontal 3D spoiled gradient-echo magnetic resonance lymphangiography (MRL) MIP-image, obtained 35 minutes after gadoteridol injection, clearly depicts several enlarged lymphatic vessels at the level of the left foot and lower leg with a network of collateral formations (arrows). Note the parallel enhancing veins, which show a lower signal intensity (arrowheads). B, Angled 3D spoiled gradient-echo MRL MIP-image, obtained 35 minutes after gadoteridol injection, clearly depicts seveleral enlarged lymphatic vessels at the level of the left foot and lower leg with a network of collateral formations (arrows). The collateralization involves hereby both the epifascial and subfascial lymphatic system. Note the parallel enhancing vein, which shows a lower signal intensity (arrowhead). C, Frontal 3D spoiled gradient-echo source image, obtained 35 minutes after gadoteridol injection, clearly delineates the enlarged epifascial lymphatic vessels (arrowheads), subfascial lymphatic vessels (asterisk), and the perforating lymphatics (arrow), combining the epifascial with the subfascial lymphatic system. Note the close anatomic relationship of the deep lymphatic vessels with the tibia. Journal of Vascular Surgery 2009 49, 417-423DOI: (10.1016/j.jvs.2008.08.069) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

Fig 3 A 35-year-old man with unilateral secondary lymphedema due to a car accident with direct trauma to the left lower leg with tibial fracture. Frontal 3D spoiled gradient-echo magnetic resonance lymphangiography (MRL) MIP-image, obtained 35 minutes after gadoteridol injection, reveals a small lymphatic aneurysm of 7 mm at the middle level of the calf. Furthermore, the lateral aspect of the lymphatic system was enhanced in addition to the ventro-medial bundle. Journal of Vascular Surgery 2009 49, 417-423DOI: (10.1016/j.jvs.2008.08.069) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions