lymphocele

A lymphocele is a collection of lymphatic fluid that occurs within the body, typically as a complication after surgery. It is characterized by a cystic mass that can form in various regions, including the pelvic retroperitoneum or paraaortic region.

Key Features:

• A lymphocele is a cyst containing lymphatic fluid [7].
• It has no distinct epithelial lining [6].
• Lymphoceles are collections of leaked lymphatic fluid [6].
• They can occur in various regions, including the pelvic retroperitoneum or paraaortic region [5].

Formation:

• A lymphocele forms when the lymphatic system gets damaged during surgery [1].
• It typically occurs within 3-8 weeks after surgery, but may occur later [2].

Types and Locations:

• Lymphoceles can be unilocular or multilocular cystic masses [8].
• They are most frequently found in the postoperative setting [3][9].
• In rare cases, lymphoceles can also occur as neck masses that mimic other congenital, infectious, or malignant conditions [8].

Note: The information provided is based on the search results and context provided.

Lymphoceles are typically asymptomatic, but larger ones can cause symptoms related to compression of adjacent structures leading to lower extremity swelling, abdominal pain, fever, and other nonspecific symptoms [3][8].

Some common signs and symptoms associated with lymphoceles include:

• Lower extremity swelling: This is a common symptom caused by the compression of veins in the affected area [2].
• Abdominal pain: Pain in the abdomen can occur due to the compression of adjacent structures, such as the intestines or other organs [7][8].
• Fever: Fever is another symptom that can occur in some cases, especially if the lymphocele becomes infected [2].
• Nonspecific symptoms: The symptoms associated with lymphoceles are often vague and nonspecific, making it difficult to diagnose the condition accurately [6-8].

It's worth noting that small lymphoceles are usually asymptomatic and may not require any treatment. However, larger ones can cause significant discomfort and may require medical attention.

References:

[1] Small lymphoceles do not cause any symptoms and thus, do not require any form of treatment. [2] In a recent series, the incidences of symptoms related to symptomatic lymphoceles were fever in 47%, abdominal pain in 40%, lower extremity swelling in 37%, ... [3] Signs and symptoms​​ Many lymphoceles are asymptomatic. Larger lymphoceles may cause symptoms related to compression of adjacent structures leading to lower ... [4] The symptoms associated with lymphocele are usually vague and nonspecific [6-8]. [5] Symptomatic lymphoceles manifest with pain, compression of adjacent structures, lymphoedema, deep vein thrombosis or inflammation.

Diagnostic Tests for Lymphocele

Lymphocele, a rare condition characterized by the accumulation of lymphatic fluid in a cystic structure, can be diagnosed through various diagnostic tests.

• Imaging Studies: Imaging studies such as CT scans, ultrasound, and MRI play an important role in diagnosing lymphocele. These tests help identify the location and size of the lymphocele, as well as any potential complications (1). A smooth, oval, or tubular mass with a thin wall that does not enhance after contrast administration is classically described for lymphoceles on CT scans (9).
• Fluid Aspiration: Fluid aspiration can be performed to yield a clear to light yellow fluid with a lymphocyte predominance (>70%) on cell count, low protein content, and the presence of fat globules (8). This test helps confirm the diagnosis of lymphocele.
• Lymphoscintigraphy: Lymphoscintigraphy can be used to detect abnormal lymphatic drainage in patients with lymphocele. It is a non-invasive test that can be repeated several times without any adverse events (3).
• Laboratory Tests: Laboratory tests such as creatinine, cell count, Gram stain, and culture may also be ordered to identify the collection as a urinoma, hematoma, abscess, or other conditions (4).

Additional Diagnostic Tests

In addition to these diagnostic tests, doctors may also order imaging tests to get a view of the patient's internal organs. These tests will help target the areas where symptoms are reported and can reveal physical abnormalities on imaging tests when the patient has a lymphocele (15).

References:

[1] - Search result 6 [3] - Search result 3 [4] - Search result 4 [8] - Search result 8 [9] - Search result 9

Lymphoceles are fluid-filled sacs that can form in the body as a result of lymphatic system damage or obstruction. When it comes to treating lymphoceles, various treatment options are available, depending on their size and complexity.

Sclerotherapy is an effective treatment strategy for resistant large lymphoceles [4]. This involves injecting a sclerosing agent into the lymphocele to cause scarring and eventual closure of the sac. The type of sclerosing agent used seems mostly based on the preference of the treating physician, with no clear consensus on which one is most effective.

Drainage with delayed addition of sclerotherapy and embolization are best in treating symptomatic postoperative pelvic lymphoceles [1]. This approach involves draining the fluid from the lymphocele and then using a combination of sclerotherapy and embolization to prevent further fluid accumulation.

Other treatment options for lymphoceles include:

• Instillation of diluted povidone iodine, which is safe and effective, and may be considered as a first-line treatment [2].
• Fibrin glue sclerotherapy, which has been shown to be a safe and effective method of treating symptomatic lymphoceles in some cases [9].

It's worth noting that smaller lymphoceles or those that are not causing any symptoms may not require treatment at all. In such cases, the condition is generally harmless and does not require any intervention.

References:

• [1] ten Hove AS (2021) Drainage with delayed addition of sclerotherapy and embolization are best in treating symptomatic postoperative pelvic lymphoceles.
• [2] Zomorrodi A (2007) Instillation of diluted povidone iodine for treatment of lymphocele and leak of lymph is safe and effective.
• [4] Sclerotherapy is an effective treatment strategy for resistant large lymphoceles.
• [9] Fibrin glue sclerotherapy may be considered a safe and effective method of treating symptomatic lymphoceles when used in conjunction with drainage.

Understanding Lymphoceles and Their Differential Diagnosis

A lymphocele is a rare, unilocular cystic neck mass that may mimic other congenital, infectious, or malignant neck cysts. The differential diagnosis for lymphocele involves considering various fluid collections in the body, including:

• Urinary tract issues: Urinoma (a collection of urine outside the urinary system) and seroma (a collection of serum outside the blood vessels)
• Hematological conditions: Hematoma (a collection of blood outside the blood vessels)
• Infectious diseases: Abscesses (collections of pus caused by infection)
• Tumors: Malignant tumors that may mimic lymphoceles in appearance and location

Key Features to Consider

When diagnosing a lymphocele, clinicians must maintain a high index of suspicion for this condition, particularly in patients with a history of lymphadenectomy (surgical removal of lymph nodes). The following features can help distinguish lymphocele from other fluid collections:

• Ultrasound features: Lymphoceles typically appear as unilocular, nonseptated cystic lesions adjacent to great pelvic vessels.
• CT or MRI findings: Enhanced imaging may show a nonenhancing supraclavicular cyst in the posterior cervical space.

Clinical Manifestations

Large lymphoceles can cause local discomfort, pain, and leg swelling. It is essential to consider these symptoms in conjunction with other fluid collections when making a differential diagnosis.

References:

• [1] The definition of lymphocele as a collection of lymphatic fluid within the body not bordered by epithelial lining.
• [2-3] The importance of considering lymphocele in the differential diagnosis for unilocular cystic neck masses.
• [4-5] The features that distinguish lymphocele from other fluid collections, such as urinoma, seroma, hematoma, and abscesses.
• [6-7] The clinical manifestations of large lymphoceles and their implications for differential diagnosis.