Abstract
To determine the different computed tomography (CT) findings of lymphedema, cellulitis, and generalized edema in the lower leg. CT images of 44 patients with confirmed lymphedema (n = 19), cellulitis (n = 11), or generalized edema (n = 14) were retrospectively reviewed. The following characteristics were evaluated: extent of edema, laterality, skin thickening, honeycombing, taller than wide appearance, muscle edema, conglomeration of septum of fat lobule, fluid collection, fascial enhancement, inguinal lymph node (LN) enlargement, medullary fat obliteration of inguinal LN, trunk subcutaneous edema, and bone marrow edema. Fisher’s exact test with Bonferroni correction was used for multiple comparisons. Honeycombing and taller than wide appearance of fat lobules were more common in lymphedema (P < 0.01). Fat obliteration of inguinal LN and inguinal LN enlargement at the affected side were more common in cellulitis (P < 0.01). Bone marrow and subcutaneous edema of the trunk were more common in generalized edema (P < 0.01). Honeycombing is commonly seen in lymphedema, but is not a specific finding. Inguinal LN enlargement is a specific sign of cellulitis. Truncal edema and bone marrow edema were specific findings of generalized edema.
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Ely JW, Osheroff JA, Chambliss ML, Ebell MH (2006) Approach to leg edema of unclear etiology. J Am Board Fam Med 19(2):148–160
Yoshida S, Akiba H, Tamakawa M, Yama N, Takeda M, Hareyama M (2001) Spiral CT venography of the lower extremities by injection via an arm vein in patients with leg swelling. Br J Radiol 74(887):1013–1016
Tiwari A, Cheng KS, Button M, Myint F, Hamilton G (2003) Differential diagnosis, investigation, and current treatment of lower limb lymphedema. Arch Surg 138(2):152–161
Pillari G, Zito J, Chang JB, Cohen JR, Greenspan B, Gersten K, Wenig P, Lewin B, Rizzo A (1987) Lower extremity swelling: computerized tomography following negative venography. Cardiovasc Intervent Radiol 10(5):261–263
Stein PD, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD, Leeper KV Jr, Popovich J Jr, Quinn DA, Sos TA, Sostman HD, Tapson VF, Wakefield TW, Weg JG, Woodard PK, Investigators PI (2006) Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 354(22):2317–2327
He J, Wang F, Dai HJ, Li M, Wang Q, Yao Z, Lv B, Xiong CM, He JG, Liu ZH, He ZX, Fang W (2012) Chinese multi-center study of lung scintigraphy and CT pulmonary angiography for the diagnosis of pulmonary embolism. Int J Cardiovasc Imaging 28(7):1799–1805
Yankelevitz DF, Gamsu G, Shah A, Rademaker J, Shaham D, Buckshee N, Cham MD, Henschke CI (2000) Optimization of combined CT pulmonary angiography with lower extremity CT venography. AJR Am J Roentgenol 174(1):67–69
Katz DS, Loud PA, Bruce D, Gittleman AM, Mueller R, Klippenstein DL, Grossman ZD (2002) Combined CT venography and pulmonary angiography: a comprehensive review. Radiographics 22 Spec No:S3-19; discussion S20-14
Monnin-Delhom ED, Gallix BP, Achard C, Bruel JM, Janbon C (2002) High resolution unenhanced computed tomography in patients with swollen legs. Lymphology 35(3):121–128
Lin YT, Tsai IC, Tsai WL, Chen MC, Lin PC, Chan SW, Chen CC (2010) Comprehensive evaluation of patients suspected with deep vein thrombosis using indirect CT venography with multi-detector row technology: from protocol to interpretation. Int J Cardiovasc Imaging 26(Suppl 2):311–322
Vaughan BF (1990) CT of swollen legs. Clin Radiol 41(1):24–30
Hadjis NS, Carr DH, Banks L, Pflug JJ (1985) The role of CT in the diagnosis of primary lymphedema of the lower limb. AJR Am J Roentgenol 144(2):361–364
Marotel M, Cluzan R, Pascot M, Ghabboun S, Alliot F, Lasry JL (1998) Computerized tomography of 150 cases of lymphedema of the leg. J Radiol 79(11):1373–1378
Spira D, Weisel K, Brodoefel H, Schulze M, Kaufmann S, Horger M (2012) Can whole-body low-dose multidetector CT exclude the presence of myeloma bone disease in patients with monoclonal gammopathy of undetermined significance (MGUS)? Acad Radiol 19(1):89–94
Henes FO, Groth M, Bley TA, Regier M, Nuchtern JV, Ittrich H, Treszl A, Adam G, Bannas P (2012) Quantitative assessment of bone marrow attenuation values at MDCT: an objective tool for the detection of bone bruise related to occult sacral insufficiency fractures. Eur Radiol 22(10):2229–2236
Horger M, Pereira P, Claussen CD, Kanz L, Vonthein R, Denecke B, Driessen C (2008) Hyperattenuating bone marrow abnormalities in myeloma patients using whole-body non-enhanced low-dose MDCT: correlation with haematological parameters. Br J Radiol 81(965):386–396
Helms CA, Cann CE, Brunelle FO, Gilula LA, Chafetz N, Genant HK (1981) Detection of bone-marrow metastases using quantitative computed tomography. Radiology 140(3):745–750
Pache G, Krauss B, Strohm P, Saueressig U, Blanke P, Bulla S, Schafer O, Helwig P, Kotter E, Langer M, Baumann T (2010) Dual-energy CT virtual noncalcium technique: detecting posttraumatic bone marrow lesions–feasibility study. Radiology 256(2):617–624
Maldjian C, Curtis BR, Gatenby R, Milestone B, Revesz G (1999) Clinical significance of increased density in the proximal femoral marrow detected by visual inspection on abdominopelvic postcontrast CT examination. J Comput Assist Tomogr 23(3):448–453
Brautigam P, Vanscheidt W, Foldi E, Krause T, Moser E (1993) The importance of the subfascial lymphatics in the diagnosis of lower limb edema: investigations with semiquantitative lymphoscintigraphy. Angiology 44(6):464–470
Marotel M, Cluzan R, Ghabboun S, Pascot M, Alliot F, Lasry JL (1998) Transaxial computer tomography of lower extremity lymphedema. Lymphology 31(4):180–185
Fayad LM, Carrino JA, Fishman EK (2007) Musculoskeletal infection: role of CT in the emergency department. Radiographics 27(6):1723–1736
Katch V, Weltman A (1975) Predictability of body segment volumes in living subjects. Hum Biol 47(2):203–218
Stanton AW, Badger C, Sitzia J (2000) Non-invasive assessment of the lymphedematous limb. Lymphology 33(3):122–135
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Shin, S.U., Lee, W., Park, EA. et al. Comparison of characteristic CT findings of lymphedema, cellulitis, and generalized edema in lower leg swelling. Int J Cardiovasc Imaging 29 (Suppl 2), 135–143 (2013). https://doi.org/10.1007/s10554-013-0332-5
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DOI: https://doi.org/10.1007/s10554-013-0332-5