[Skip to Content]
[Skip to Content Landing]
March 22, 1993

Lymphatic Abnormalities in Human Filariasis as Depicted by Lymphangioscintigraphy

Author Affiliations
From the Departments of Surgery (Drs M. Witte, C. Witte, and Case) and Radiology (Nuclear Medicine) (Dr Williams and Mr McNeill), University of Arizona, Tucson, the Department of Plastic Surgery, Thanjavur (Tamil Nadu) Medical College (Dr Jamal), the Indian Council on Medical Research Tuberculosis Center (Dr Kumaraswami), and the Department of Radiology, K-J Hospital (Dr Panicker), Madras, Tamil Nadu.
Arch Intern Med. 1993;153(6):737-744. doi:10.1001/archinte.1993.00410060045008

Background:  Investigation into filarial lymphedema has been hampered by the lack of a simple, safe, and easily repeated test to image the peripheral lymphatic system. Recent refinements in radionuclide lymphangioscintigraphy have established this noninvasive technique as the initial procedure of choice for visualizing lymphatics. Accordingly, we applied lymphangioscintigraphy to patients with filariasis and, for purposes of interpretation, compared the findings with those in patients with nonfilarial lymphedema.

Methods:  Thirty-three patients with classic symptoms or signs consistent with acute or chronic filariasis underwent lymphangioscintigraphy, and the findings were compared with those in five patients without lymphatic dysfunction and in 50 other patients with primary or secondary lymphedema without exposure to filariasis.

Results:  As in patients with nonfilarial lymphedema, scintigraphic abnormalities in the 33 patients with filariasis included delayed or absent tracer transport of the radiotracer (25 patients), tortuous and bizarre deep lymphatics (seven patients), dermal diffusion (15 patients), retrograde tracer flow (six patients), and faint or absent regional nodal visualization (14 patients). Even in patients with long-standing filarial lymphedema, peripheral trunks were often visualized (at least in part), and regional nodes and more central lymphatics sometimes filled after light exercise. In some of the latter patients, however, discrete lymphatic trunks were not detected.

Conclusion:  Lymphangioscintigraphy is a simple, safe, reliable, noninvasive method with which to examine the peripheral lymphatic system, including truncal and nodal abnormalities, in endemic populations with occult and overt lymphatic filariasis.(Arch Intern Med. 1993;153:737-744)

DaRocha RM.  Linfangiografia no ostido da filariáse linfática .  Ann Inst Med Trop. 1964;21:23-74.
Cahill KM.  Lymphography in bancroftian filariasis . In: Gooneratne BWM, ed.  Lymphography: Clinical and Experimental . Stoneham, Mass: Butterworths; 1974: 71-82.
Gooneratne BWM.  Lymphography in experimental filariasis .  In: Lymphography: Clinical and Experimental . Stoneham, Mass: Butterworths; 1974:83-121.
Nawaz K, Hamad M, Sadek S, et al.  Lymphscintigraphy in peripheral lymphedema using technetium-labelled human serum albumin: normal and abnormal patterns .  Lymphology . 1985:18:181-186.
McNeill GC, Witte MH, Witte CL, et al.  Whole-body lymphangioscintigraphy: the preferred method for the initial assessment of the peripheral lymphatic system .  Radiology . 1989;172:495-502.Crossref
Weissleder H, Weissleder R.  Lymphedema: evaluation of qualitative and quantitative lymphoscintigraphy in 238 patients .  Radiology . 1988;167:729-735.Crossref
Ege GN.  Lymphoscintigraphy: techniques and applications in the management of breast carcinoma .  Semin Nucl Med. 1983;13:26-34.Crossref
Binford CH, Connor DH.  Pathology of Tropical and Extraordinary Diseases . Washington, DC: Armed Forces Institute of Pathology; 1976;2:340-369.
Jamal S.  Dramatic manifestations of filarial infection (W. bancrofti) .  Lymphology . 1985;18:145-147.
Yamauchi SH.  Lymphatic filariasis . In: Foldi W, Casley-Smith JR, eds.  Lymphangiology . New York, NY: FK Schattauer Verlag; 1983:747-767.
Ewert A, Folse D.  Lymphatic filariasis .  Am J Pathol. 1984;115:135-137.
Hines SA, Williams JL, Doyle TJ, Carndall RB, Crandall CA, Nayar JK.  Lymphangiography in ferrets infected with Brugia malayi .  Lymphology . 1985; 18:173-174.
Vickery AC, Nayar JK, Albertine KH.  Differential pathogenicity of Brugia malayi, B. patei and B. pahangi in immunodeficient nude mice .  Acta Trop (Basel) . 1985; 42:353-363.
Altorfer J, Clodius L.  Chronic experimental lymphedema of the extremities: pathological changes .  Experientia . 1976;32:823-824.Crossref
Olszewski W.  On the pathomechanism of development of postsurgical lymphedema .  Lymphology . 1973;6:35-51.
Tan TJ, Kosin E, Tan TH.  Lymphographic abnormalities in patients with Brugia malayi filariasis and 'idiopathic tropical eosinophilia.'  Lymphology . 1985;18: 169-172.
McBrien MP, Edwards JM, Kinmonth JB.  Lymphography of the testes and its adnexa in the normal and in idiopathic hydrocele .  Arch Surg. 1972;104:820-825.Crossref
Witte MH, McNeill G, Crandall C, et al.  Whole body lymphangioscintigraphy in chronic Brugia malayi infection in ferrets .  Lymphology . 1988;21:251-257.
Case TC, Witte MH, Way DS, Witte CL, Crandall CA, Crandall RB.  Videomicroscopy of intralymphatic-dwelling Brugia malayi .  Ann Trop Med Parasitol . 1992;86:435-438.
Case T, Leis B, Witte M, et al.  Vascular abnormalities in experimental and human lymphatic filariasis .  Lymphology . 1991;24:174-183.