Display options
Cite
Smith CL, Liu M, Saravanan M, et al. Liver lymphatic anatomy and role in systemic lymphatic disease. Eur Radiol. 2021;32(1):112-121doi: 10.1007/s00330-021-08098-z.
Smith, C. L., Liu, M., Saravanan, M., Dewitt, A. G., Biko, D. M., Pinto, E. M., Escobar, F. A., Krishnamurthy, G., Brownell, J. N., Mamula, P., Glatz, A. C., Gillespie, M. J., O'Byrne, M. L., Ravishankar, C., Rome, J. J., & Dori, Y. (2022). Liver lymphatic anatomy and role in systemic lymphatic disease. European radiology, 32(1), 112-121. https://doi.org/10.1007/s00330-021-08098-z
Smith, Christopher L, et al. "Liver lymphatic anatomy and role in systemic lymphatic disease." European radiology vol. 32,1 (2022): 112-121. doi: https://doi.org/10.1007/s00330-021-08098-z
Smith CL, Liu M, Saravanan M, Dewitt AG, Biko DM, Pinto EM, Escobar FA, Krishnamurthy G, Brownell JN, Mamula P, Glatz AC, Gillespie MJ, O'Byrne ML, Ravishankar C, Rome JJ, Dori Y. Liver lymphatic anatomy and role in systemic lymphatic disease. Eur Radiol. 2022 Jan;32(1):112-121. doi: 10.1007/s00330-021-08098-z. Epub 2021 Jun 24. PMID: 34165621.
Copy Download .nbib Format: NLM
Share it on

Eur Radiol. 2022 Jan;32(1):112-121. doi: 10.1007/s00330-021-08098-z. Epub 2021 Jun 24.

Liver lymphatic anatomy and role in systemic lymphatic disease.

European radiology

Christopher L Smith, Mandi Liu, Madhumitha Saravanan, Aaron G Dewitt, David M Biko, Erin M Pinto, Fernando A Escobar, Ganesh Krishnamurthy, Jefferson N Brownell, Petar Mamula, Andrew C Glatz, Matthew J Gillespie, Michael L O'Byrne, Chitra Ravishankar, Jonathan J Rome, Yoav Dori

Affiliations

  1. Jill and Mark Fishman Center for Lymphatic Disorders, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA. [email protected].
  2. Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics Perelman School of Medicine at The University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA. [email protected].
  3. Jill and Mark Fishman Center for Lymphatic Disorders, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
  4. Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics Perelman School of Medicine at The University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
  5. Department of Radiology, The Children's Hospital of Philadelphia and Perelman School of Medicine at The University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
  6. Division of Gastroenterology, The Children's Hospital of Philadelphia and Department of Pediatrics Perelman School of Medicine at The University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.

PMID: 34165621 DOI: 10.1007/s00330-021-08098-z

Abstract

OBJECTIVES: To characterize hepatic to systemic lymphatic connections in patients with systemic lymphatic disease using intra-hepatic lymphangiography and to compare outcomes after lymphatic intervention.

METHODS: In this retrospective study, patients with intra-hepatic lymphangiography from May 2014 - April 2019 at our institution were included. Imaging review was performed and hepatic lymphatic connections and flow patterns were characterized. Clinical data were reviewed and comparisons between patients undergoing lymphatic intervention with or without abnormal hepatic lymphatics were performed.

RESULTS: During the study period, 105 patients underwent intra-hepatic lymphangiography. Primary clinical presentation included ascites (19/105), chylothorax (27/105), plastic bronchitis (PB) (17/105), and protein losing enteropathy (PLE) (42/105). Five categories of hepatic lymphatic connections and flow patterns were identified (%): normal (25%, 26/105), hepatoperitoneal (12%, 13/105), hepatopulmonary (10.5%, 11/105), hepatomesenteric (7.5%, 8/105), and hepatoduodenal (41%, 43/105) with four patients having more than one abnormal pattern. A comparison between clinical presentation and imaging category revealed an increased likelihood of having ascites with hepatoperitoneal (p < .0001), chylothorax/PB with hepatopulmonary (p = .01), and PLE with hepatoduodenal (p < .001) connections. Seventy-six patients had a lymphatic intervention, 24% with normal, and 76% with abnormal liver lymphatics. There was no difference in length of hospital stay or mortality between the two groups, but there was a prolonged time to symptom resolution (p = .006) and persistent symptoms after 6 months (5% vs 44%, p = .002) in the group with abnormal liver lymphatics.

CONCLUSION: We identified five liver lymphatic imaging categories with a substantial correlation to presenting lymphatic disease. Abnormal imaging patterns correlated with increased morbidity. Evaluation of liver lymphatics should be considered in patients with a systemic lymphatic disease if central lymphatic imaging is normal.

KEY POINTS: • We identified five liver lymphatic imaging patterns: normal, hepatoperitoneal, hepatomesenteric, hepatopulmonary, and hepatoduodenal. • Imaging patterns were correlated with disease presentation (normal - chylothorax/PB, hepatoperitoneal - ascites/chylothorax, hepatopulmonary - chylothorax/PB, hepatoduodenal - PLE). • Abnormal imaging patterns correlated with increased morbidity.

© 2021. The Author(s).

Keywords: Ascites; Chylothorax; Liver; Lymphatic diseases; Lymphography

References

  1. Swartz MA (2001) The physiology of the lymphatic system. Adv Drug Deliv Rev 50:3–20 - PubMed
  2. Ohtani O, Ohtani Y (2008) Lymph circulation in the liver. Anat Rec (Hoboken) 291:643–652 - PubMed
  3. Dumont AE, Mulholland JH (1960) Flow rate and composition of thoracic-duct lymph in patients with cirrhosis. N Engl J Med 263:471–474 - PubMed
  4. Dumont AE, Clauss RH, Reed GE, Tice DA (1963) Lymph drainage in patients with congestive heart failure. Comparison with findings in hepatic cirrhosis. N Engl J Med 269:949–952 - PubMed
  5. Ito M, Mishima Y, Sato T (1991) An anatomical study of the lymphatic drainage of the gallbladder. Surg Radiol Anat 13:89–104 - PubMed
  6. Ludwig J, Linhart P, Baggenstoss AH (1968) Hepatic lymph drainage in cirrhosis and congestive heart failure. A postmortem lymphangiographic study. Arch Pathol 86:551–562 - PubMed
  7. Lupinacci RM, Paye F, Coelho FF, Kruger JA, Herman P (2014) Lymphatic drainage of the liver and its implications in the management of colorectal cancer liver metastases. Updates Surg 66:239–245 - PubMed
  8. Moszkowicz D, Cauchy F, Dokmak S, Belghiti J (2012) Routine pedicular lymphadenectomy for colorectal liver metastases. J Am Coll Surg 214:e39–e45 - PubMed
  9. Trutmann M, Sasse D (1994) The lymphatics of the liver. Anat Embryol (Berl) 190:201–209 - PubMed
  10. Dori Y, Keller MS, Rome JJ et al (2016) Percutaneous lymphatic embolization of abnormal pulmonary lymphatic flow as treatment of plastic bronchitis in patients with congenital heart disease. Circulation 133:1160–1170 - PubMed
  11. Itkin M, Piccoli DA, Nadolski G et al (2017) Protein-losing enteropathy in patients with congenital heart disease. J Am Coll Cardiol 69:2929–2937 - PubMed
  12. Savla JJ, Itkin M, Rossano JW, Dori Y (2017) Post-operative Chylothorax in patients with congenital heart disease. J Am Coll Cardiol 69:2410–2422 - PubMed
  13. Allen KY, Downing TE, Glatz AC et al (2017) Effect of Fontan-associated morbidities on survival with intact Fontan circulation. Am J Cardiol 119:1866–1871 - PubMed
  14. Malcic I, Sauer U, Stern H et al (1992) The influence of pulmonary artery banding on outcome after the Fontan operation. J Thorac Cardiovasc Surg 104:743–747 - PubMed
  15. Mery CM, Moffett BS, Khan MS et al (2014) Incidence and treatment of chylothorax after cardiac surgery in children: analysis of a large multi-institution database. J Thorac Cardiovasc Surg 147(678–686):e671 discussion 685-676 - PubMed
  16. Caruthers RL, Kempa M, Loo A et al (2013) Demographic characteristics and estimated prevalence of Fontan-associated plastic bronchitis. Pediatr Cardiol 34:256–261 - PubMed
  17. Mertens L, Hagler DJ, Sauer U, Somerville J, Gewillig M (1998) Protein-losing enteropathy after the Fontan operation: an international multicenter study. PLE study group J. Thorac Cardiovasc Surg 115:1063–1073 - PubMed
  18. Dori Y, Itkin M (2016) Etiology and new treatment options for patients with plastic bronchitis. J Thorac Cardiovasc Surg 152:e49–e50 - PubMed
  19. Guez D, Nadolski GJ, Pukenas BA, Itkin M (2014) Transhepatic lymphatic embolization of intractable hepatic lymphorrhea. J Vasc Interv Radiol 25:149–150 - PubMed
  20. Biko DM, Smith CL, Otero HJ et al (2019) Intrahepatic dynamic contrast MR lymphangiography: initial experience with a new technique for the assessment of liver lymphatics. Eur Radiol 29:5190–5196 - PubMed
  21. Clain D, McNulty J (1968) A radiological study of the lymphatics of the liver. Br J Radiol 41:662–668 - PubMed
  22. Moreno AH, Ruzicka FF, Rousselot LM et al (1963) Functional Hepatography. Radiology 81:65–79 - PubMed
  23. Arrive L, Monnier-Cholley L, Cazzagon N, Wendum D, Chambenois E, El Mouhadi S (2019) Non-contrast MR lymphography of the lymphatic system of the liver. Eur Radiol 29:5879–5888 - PubMed
  24. Chan EH, Russell JL, Williams WG, Van Arsdell GS, Coles JG, McCrindle BW (2005) Postoperative chylothorax after cardiothoracic surgery in children. Ann Thorac Surg 80:1864–1870 - PubMed
  25. Do P, Randhawa I, Chin T, Parsapour K, Nussbaum E (2012) Successful management of plastic bronchitis in a child post Fontan: case report and literature review. Lung 190:463–468 - PubMed
  26. Dori Y, Keller MS, Rychik J, Itkin M (2014) Successful treatment of plastic bronchitis by selective lymphatic embolization in a Fontan patient. Pediatrics 134:e590–e595 - PubMed
  27. Itkin MG, McCormack FX, Dori Y (2016) Diagnosis and treatment of lymphatic plastic bronchitis in adults using advanced lymphatic imaging and percutaneous embolization. Ann Am Thorac Soc 13:1689–1696 - PubMed
  28. Bhardwaj R, Vaziri H, Gautam A, Ballesteros E, Karimeddini D, Wu GY (2018) Chylous ascites: a review of pathogenesis, diagnosis and treatment. J Clin Transl Hepatol 6:105–113 - PubMed

Publication Types