Presence of thoracic duct abnormalities in patients with primary lymphoedema of the extremities

Objectives: Primary lymphoedema is said to be caused by lymph duct malformations, lymphatic hypoplasia or lymphatic agenesis, but no definite treatment has been established. In this study, we used magnetic resonance thoracic ductography (MRTD) to assess the morphology of the thoracic duct in patients with primary lymphoedema. Methods: The study was conducted on nine patients with primary lymphoedema who were hospitalised at the Department of Plastic and Reconstructive Surgery (University of Tokyo Hospital) from September 2007 through April 2011. Results: The patients consisted of five men and four women, aged 20-54 years (mean age: 31.1 years). Five of them were in early-onset group and the rest were in late-onset group. In the 6 months prior to the onset of oedema, three of the four patients in the late-onset group had episodes of trauma near the areas which would later be affected by lymphoedema. MRTD showed no clear image of the thoracic duct in four of five patients in the early-onset group. Conclusions: MRTD assessment of patients diagnosed as 'primary lymphoedema' indicates that the pathogenetic mechanisms seen in late-onset patients are completely different from those found in early-onset patients, and may be classified as 'traumatic lymphoedema.' (C) 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.