False positive lower limb lymphoscintigraphy due to inadvertent intra-vascular injection of the tracer: Importance of tracer re-injection

Document Type: Case Report

Authors

1 Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Vascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

We presented a 30 year-old woman presented with symmetrical swelling of the lower limbs since 5 years ago with sparing of the feet. She was highly suspicious of having lipoedema and was referred for lower limb lymphoscintigraphy to rule out possible lymphedema. Lymphoscintigraphy images showed asymmetrical injection sites and unusually high liver and spleen uptake. Inguinal nodes was not visualized on the right side. With the suspicion of inadvertent intra-vascular injection, another injection was done on the right side. Repeated imaging showed inguinal nodes with normal uptake. In conclusion, in case of any suspicion of intra-vascular injection of the radiotracer in limb lymphoscintigraphy, re-injection of the tracer can be of especial use to avoid false positive results.

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  1. Aliakbarian M, Memar B, Jangjoo A, Zakavi SR, Reza Dabbagh Kakhki V, Aryana K, Forghani MN, Sadeghi R. Factors influencing the time of sentinel node visualization in breast cancer patients using intradermal injection of the radiotracer. Am J Surg. 2011 Aug;202(2):199-202.
  2. Ansari M, Rad MA, Hassanzadeh M, Gholami H, Yousefi Z, Dabbagh VR, Sadeghi R. Sentinel node biopsy in endometrial cancer: systematic review and meta-analysis of the literature. Eur J Gynaecol Oncol. 2013;34(5):387-401.
  3. Sadeghi R, Kazemzadeh G, Keshtgar M. Diagnostic application of lymphoscintigraphy in the management of lymphoedema. Hell J Nucl Med. 2010 Jan-Apr;13(1):6-10.
  4. Peña Quián Y, Hernández Ramirez P, Batista Cuellar JF, Perera Pintado A, Coca Pérez MA. Lymphoscintigraphy for the assessment of autologous stem cell implantation in chronic lymphedema. Clin Nucl Med. 2015 Mar;40(3):217-9.
  5. Burnand KM, Glass DM, Mortimer PS, Peters AM. Lymphatic dysfunction in the apparently clinically normal contralateral limbs of patients with unilateral lower limb swelling. Clin Nucl Med. 2012 Jan;37(1):9-13.
  6. Stolldorf DP, Dietrich MS, Ridner SH. Symptom Frequency, Intensity, and Distress in Patients with Lower Limb Lymphedema. Lymphat Res Biol. 2016 Jun;14(2):78-87.
  7. Kazemzadeh GH, Sadeghi R, Ebrahimi E, Rad MA. A successful experience in managing a chylous reflux: importance of lymphoscintigraphy. Clin Nucl Med. 2014 May;39(5):485-7.
  8. Ravari H, Sadri K, Sadeghi R. Growth plate uptake of Tc-99m-phytate on lymphoscintigraphy images. Lymphat Res Biol. 2015 Mar;13(1):59-61.
  9. Shariati F, Ravari H, Kazemzadeh G, Sadeghi R. Isolated primary lymphedema tarda of the upper limb. Lymphat Res Biol. 2013 Mar;11(1):43-5.
  10. Dabbagh Kakhki VR, Jangjoo A, Tavassoli A, Asadi M, Sadri K, Fatahi Masoom A, Mehrabibahar M, Memar B, Ansari M, Sadeghi R. Sentinel node mapping for early breast cancer patients using 99mTc-phytate: Single center experience on 165 patients. Iran J Nucl Med. 2012;20(2):25-9.
  11. Sadri K, Ayati NK, Shabani G, Zakavi SR, Sadeghi R. Sentinel node detection failure due to defective labeling and large particle size of Tc-99m antimony sulfide colloid. Iran J Nucl Med. 2011;19(1):6-11.
  12. Szuba A, Shin WS, Strauss HW, Rockson S. The third circulation: radionuclide lymphoscintigraphy in the evaluation of lymphedema. J Nucl Med. 2003 Jan;44(1):43-57.