ORIGINAL ARTICLE  MISCELLANEOUS Editor’s choice • Free access

International Angiology 2019 August;38(4):334-42

DOI: 10.23736/S0392-9590.19.04176-2

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Upper limb secondary lymphedema ultrasound mapping and characterization

Antonio MANDER ¹, Salvatore VENOSI ², Erica MENEGATTI ³, Lee BYUNG-BOONG ^{4, 5}, Diana NEUHARDT ⁶, Elisa MAIETTI ^{7, 8}, Sergio GIANESINI ^{3, 5} ✉

¹ Unit of Oncologic and Vascular Rehabilitation, Vaclav Vojta Center, Rome, Italy; ² Unit of Vascular Surgery, Paride Stefanini Department, Sapienza University, Rome, Italy; ³ Unit of Translational Surgery, Vascular Disease Center, University of Ferrara, Ferrara, Italy; ⁴ George Washington University, Washington DC, USA; ⁵ Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; ⁶ Comprehensive Interventional Care Center, Gilbert, AZ, USA; ⁷ Department of Medical Sciences, Center for Clinical Epidemiology, University of Ferrara, Ferrara, Italy; ⁸ Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy

BACKGROUND: Ultrasound investigation potentials in lymphedema are still to be fully used in everyday practice. Aim of the present study was to report the sonographic characterization of the dermo-epidermal complex (DEC) and of the subcutaneous (SUBC) tissue, assessing the feasibility of a related mapping, in upper limb secondary lymphedema.
METHODS: In this retrospective study 287 patients affected by monolateral upper limb post-mastectomy lymphedema (M5/F282; mean age 64±4.24) were enrolled and scanned by ultrasound, considering the healthy contralateral limb as control. In order to standardize the assessment, the limb was divided in sectors: 4 anterior, 4 posterior below the elbow, 4 anterior and 4 posterior above the elbow, plus the hand. DEC and SUBC regions B-mode appearance were reported, both in the healthy and in the pathological arms. DEC thickness was measured and compared among the same sectors of the healthy and pathological limbs.
RESULTS: DEC and SUBC sonographic appearance was differentiated in fluid and sclerotic. DEC included a third category characterized by differentiation loss. The different sectors showed significantly different lymphatic involvement in the affected limb. In the comparison with the contralateral unaffected segments a significantly thicker DEC was reported in the forearm affected by lymphedema (P<0.005), while no significant difference was reported at the arm level.
CONCLUSIONS: Traditional ultrasonography can provide a secondary upper limb lymphedema characterization with related mapping and useful data for a better lymphatic physiopathology understanding and for a properly addressed therapeutic protocol.

KEY WORDS: Ultrasonography; Lymphedema; Upper extremity