We have some diagnostic problems with a 35-year old female with painless oedema of the right lower extremity. On ultrasound, no DVT was found but cystic lesion surrounding right saphenous vein. No blood flow was detected by Doppler in those cystic hypoechoic structures. MRI of the abdomen and pelvis did not reveal any abnormalities, no retroperitoneal lymph nodes. Has anyone seen such ultrasound findings?
One possibility can be hydatid cyst, keenly look for a cart wheel appearance or septae inside the cyst. Get serum levels for echinococcus or evidence of scolex inside. I can see some septa and material inside the cyst which one may be able to appreciate on high gain settings.
Most likely a lymphatic malformation (aka lymphangioma, an old-fashioned terminology) with accompanying one-sided lymphedema. They tend to be congenital but evolve very slowly, with spontaneous bouts and partial remissions. Refer this patient to the vascular anomalies specialized center nearest from you. Treatment options include sclerotherapy and surgery.
I believe this specialist has experience (do not know him, only read his publications):
Jyotsna Murthy
Professor, Department of Plastic Surgery
Chief Coordinator –Cleft & Craniofacial Center
SRMC & RI, Sri Ramachandra Univeristy
Porur, Chennai 600 116, India
Contact Details Tel: +91 44 24765617
Mobile : +98410 39820
Fax: +91 44 24767008
E-mail: [email protected]
Web : www.aesthetics-chennai.com, www.cleftcare.og
Thanks a lot-that is what we plan to do. What do you think about lymphoscyntygraphy? Is wait and see policy acceptable in this case? Thanks for your help - we wil try to conntact Prof. Murthy.
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