Intradermal-Stress-Lymphoscintigraphy in Early Detection and Clinical Management of Secondary Lymphedema: A Pictorial Essay.

Stress-lymphoscintigraphy evaluates the effects of exercise on lymph drainage. Results may predict outcomes of complex physical therapy as a first-line lymphedema treatment. Microsurgical approaches are best in patients with lymphangectasia or dermal backflow. Lymphatic pathway mapping helps plan lympho-venous anastomoses. For improved lymphatic visualization, we suggest a scan at rest, after a quick exercise (stepping or weight lifting for 2 min) and delayed scanning after prolonged symptom limited exercise (walking or hand squeezing for 30-40 min). In advanced lymphedema, identification of lymph pathways and residual regional lymph nodes might be difficult. In these patients, lymph node transplant is suggested.