Lymphoscintigraphic Bilateral Disease in Patients with Clinically Unilateral Primary Lower Limb Lymphedemas.
Level 4 - case-series / case-control
Retrospective observational case series
PubMed 33270523 · doi:10.1089/lrb.2020.0041
What was done
Researchers conducted a retrospective review of a clinical database examining 103 patients referred for lymphoscintigraphy (LySc) who presented with clinically unilateral primary lower limb lymphedema and demonstrated distal dermal backflow (DDB). Patients were classified into early-onset ("praecox", Group 1: n = 56, 8 men, 48 women, median age 32.5 years) and late-onset ("tarda", Group 2: n = 47, 8 men, 39 women) groups to assess the frequency of DDB in the contralateral, nonedematous limb.
What was found
Contralateral DDB in the clinically unaffected limb was present in 38.8% of the total cohort. It was significantly more frequent (p < 0.001) in Group 2 (70%) than in Group 1 (15%). Within Group 1, bilateral involvement occurred in 4 of 33 patients aged under 35 years and in 4 of 23 patients aged 35 years or older.
Why it matters
Subclinical lymphatic dysfunction is common in the contralateral limb of patients presenting with unilateral primary lymphedema, especially in late-onset cases. This distinction suggests that early-onset and late-onset lymphedema may represent two distinct pathological entities or differ in population susceptibility.
Limits
The study is limited by its retrospective design and single-institution database. Inclusion required evidence of DDB on imaging, introducing selection bias. The abstract does not report longitudinal follow-up to determine whether subclinical contralateral lesions eventually progressed to clinical edema.
Cited by
- contradicts Lymphedema typically occurs on one side of the body rather than bilaterally.