Atypical pelvic lymphocele: Sonographic appearance

✍ Scribed by B. M. Carrington; R. J. Johnson

• Publisher: John Wiley and Sons
• Year: 1993
• Tongue: English
• Weight: 480 KB
• Volume: 21
• Category: Article
• ISSN: 0091-2751
• DOI: 10.1002/jcu.1870210208

✦ Synopsis

A lymphocele (lymphocyst) is an extraperitoneal CASE REPORT collection of lymph fluid, which is contained by the parietal peritoneum and has no identifiable epithelial lining. Most pelvic lymphoceles occur after lymphadenectomy for malignant disease, although they are a recognized complication of nephrectomy and tran~plantation.',~,~ Factors implicated in the pathogenesis of lymphoceles include lymph node involvement by tumor, prior radiotherapy, retroperitoneal (as opposed to transperitoneal) lymph node dissection, and anticoagulant therapy, which may prevent obliteration of the severed lymph vessel^.^'^,^,^

The reported incidence of lymphoceles ranges between 1% and 49%, but most recent series record a lower incidence of less than 5%.6,7,s Lymphoceles usually accumulate within days or weeks of surgery2,' but occasionally may not form until many years later. Patients may remain asymptomatic or present with pain, signs of infection, or symptoms due to mass effect such as venous obstruction or urinary frequency.','' Small lymphoceles frequently undergo spontaneous resolution, whereas large lymphoceles are more likely to require treatment."

Lymphoceles have a characteristic sonographic appearance.l1.l2 They are typically located in the retroperitoneum or on the pelvic sidewall and are visualized as anechoic or hypoechoic masses that demonstrate through transmission. Septae have been recorded in 2% to 25% of patients, and dependent debris may be seen, particularly when secondary infection is present." Calcification within a lymphocele is rare. We present a patient in whom a pelvic lymphocele occurred in an atypical location and with an unusual initial ultrasound appearance.