Sung Ui Shin MD, Abstract Co-Author: Nothing to Disclose

Whal Lee MD, PhD, Presenter: Nothing to Disclose

Eun-Ah Park MD, Abstract Co-Author: Nothing to Disclose

Cheong-Il Shin MD, Abstract Co-Author: Nothing to Disclose

Jin Wook Chung MD, Abstract Co-Author: Nothing to Disclose

Jae Hyung Park MD, Abstract Co-Author: Nothing to Disclose

To analyze and determine the different CT findings of lymphedema, cellulitis, and generalized edema in lower leg.

CT images of 44 patients with confirmed lymphedema (n=19), cellulitis (n=11), or generalized edema (n=14) were retrospectively reviewed. Lymphedema was confirmed by radioisotope lymphangiography. Cellultis was categorized by clinical findings and treatment outcome : such as redness, pain, heatness, swelling at initial presentation and symptom resolution after antibiotics treatment. The diagnosis of generalized edema was based on the clinical findings such as heart The following characteristics were evaluated: extent of edema, laterality, skin thickening, honeycombing, taller than wide appearance, muscle edema, conglomeration of septum of fat lobule, fluid collection, fascial enhancement, inguinal lymph node (LN) enlargement, medullary fat obliteration of inguinal LN, trunk subcutaneous edema, and bone marrow edema. Fisher’s exact test with Bonferroni correction was used for multiple comparisons.

Honeycombing and taller than wide appearance of a fat lobules were more common in lymphedema (p<0.01). Fat obliteration of inguinal LN and inguinal LN enlargement at the affected side were more common in cellulitis (p<0.01). Bone marrow and subcutaneous edema of the trunk were more common in generalized edema (p<0.01).

 Although honeycombing was previously known as a specific CT finding for lymphedema and it was also most commonly seen in lymphedema in our study, it also seen in cellulitis and generalized edema, thus, it is not a specific finding. Unilateral muscle enlargement was believed to be a sign of vein related edema, but lymphedema showed muscle enlargement in some cases. Inguinal lymph node enlargement of the affected side was found to be a specific sign of cellulitis wheras inguinal lymph node enlargement was not seen in patients with lymphedema. Truncal edema and bone marrow edema were specific findings of generalized edema. Knowledge of the characteristic CT findings of the three disease entities presented as non-venous cause leg edema will be helpful in their differential diagnosis and subsequent management.  

Combination of CT findings will be helpful in the differentiate the three disease entities presented as lower leg edema, leading to proper management to whom present with non-venous cause swollen legs

Shin, S, Lee, W, Park, E, Shin, C, Chung, J, Park, J, Comparison of Characteristic CT Findings of Lymphedema, Cellulitis and Generalized Edema in Lower Extremity Swelling.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12023299.html