Evaluation of lymphatic dysplasia in patients with congenital pleural effusion and ascites using indocyanine green lymphography.

Abstract

OBJECTIVES:

To investigate the use of indocyanine green (ICG) lymphography in the diagnosis and assessment of the severity of lymphatic dysfunction in infants and neonates with congenital lymphatic pleural effusion and ascites.

STUDY DESIGN:

We performed ICG lymphography on 10 neonates and infants with congenital lymphatic pleural effusion and ascites. After the subcutaneous injection of ICG, circumferential fluorescent images of lymphatic drainage channels in the extremities and trunk were identified using an infrared camera system. The lymphographic findings were classifiable into 2 patterns-those showing a linear lymphatic pattern, suggesting normal lymphatic flow, and those showing lymphatic channels with retrograde lymphatic flow (dermal backflow pattern), suggesting an abnormal lymphatic flow. We analyzed the severity of the ICG lymphography findings and the clinical outcomes.

RESULTS:

Based on the ICG lymphography, the severity of lymphatic dysplasia were classified into 4 categories: mild dysplasia, moderate dysplasia, severe dysplasia, and lymphatic hypoplasia. All cases diagnosed with mild (n = 3) or moderate dysplasia (n = 2) survived, and 2 of the 4 cases diagnosed with severe dysplasia died. The duration of endotracheal intubation ranged from 1 to 17 days (median, 7) in the patients with mild or moderate dysplasia and from 25 to 110 days (median, 77) in those with severe dysplasia.

CONCLUSIONS:

The ICG lymphographic findings were consistent with the clinical conditions. This imaging technique may be important to the future clinical management of lymphatic dysplasia in neonates and infants.

• Authors: Jun Shibasaki, Hisako Hara, Makoto Mihara, Shinya Adachi, Yasushi Uchida, Yasufumi Itani
• Journal: The Journal of pediatrics (J Pediatr) Vol. 164 Issue 5 Pg. 1116-1120.e1 (May 2014) ISSN: 1097-6833 [Electronic] United States
• PMID: 24518167 (Publication Type: Clinical Trial, Journal Article)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Chemical References

• Fluorescent Dyes
• Indocyanine Green

Topics

• Chylothorax (congenital, diagnostic imaging, mortality)
• Chylous Ascites (congenital, diagnostic imaging, mortality)
• Female
• Fluorescent Dyes
• Follow-Up Studies
• Humans
• Indocyanine Green
• Infant
• Infant, Newborn
• Lymphatic Abnormalities (complications, diagnostic imaging, mortality)
• Lymphography (methods)
• Male
• Pleural Effusion (congenital, diagnostic imaging, mortality)
• Prognosis
• Severity of Illness Index