Lymphatic phenotype characterisation by MR lymphangiography and near-infrared fluorescence imaging in a patient with pleural effusions and oedema.

Lymphatic dysfunction can manifest through a spectrum of clinical features, including lower limb lymphoedema and pulmonary complications such as recurrent pleural effusions. Diagnosing underlying lymphatic abnormalities remains challenging due to nonspecific symptoms and limited imaging options. This case study describes a man hospitalised for a left-sided pneumothorax followed by recurrent pleural effusions and peripheral oedema. Using non-contrast MR lymphangiography and near-infrared fluorescence imaging, lymphatic vessel abnormalities were visualised in the extremities. Imaging also revealed thoracic lymphangiectasia and dilated lymphatic vessels, resembling abnormalities observed in patients with a Fontan circulation who experience pleural effusions. This combined imaging approach shows promise for evaluating complex lymphatic phenotypes and may enable more personalised treatment strategies for patients with these symptoms.