Christian Lohrmann

Objective: Lymphocutaneous fistulas with intractable lymphatic leakage represent a serious clinical condition leading to a severe impairment of quality of life for the affected patients. To date, no adequate diagnostic imaging modality is in existence to allow selection of the correct treatment option. The aim of this study was to perform a pre-therapeutic evaluation of the lymphatic system in patients with lymphocutaneous fistulas by magnetic resonance lymphangiography (MRL).

Disseminated lymphangiomatosis is an uncommon disorder characterized by diffuse or multifocal proliferation of complex, irregular lymphatic channels involving soft tissue, viscera, retroperitoneum, eyes and the skeletal system. Currently, magnetic resonance imaging, computed tomography, ultrasonography, and conventional radiography are the favored radiologic imaging modalities in assessing the extent of pathologic changes in patients suffering from disseminated lymphangiomatosis. Historically, imaging evaluation was performed with conventional lymphography. We report on the first patient suffering from disseminated lymphangiomatosis with skeletal involvement, whose lymphatic vasculature of the lower limbs and pelvic region was evaluated with magnetic resonance lymphangiography.

Radiofrequency heat ablation (RFA) is an advanced minimal-invasive technique for the treatment of primary and secondary malignancies in several organs. This article presents the successful percutaneous computed tomography (CT)-guided radiofrequency heat ablation of a peripheral bronchiogenic carcinoma and four lung metastases in three patients. Pain relief in a palliative care situation was the indication for RFA treatment in two patients. A primary curative tumor treatment with RFA was intended in one patient, who refused surgery. All procedures were performed under conscious sedation and local anesthesia. RFA treatment was carried out without major complications in these patients. No signs of infection or significant bleeding were observed. One patient developed a pneumothorax two days after the procedure, which was drained sufficiently. All patients had elevated temperatures, up to 38.5 degrees C for three days after RFA, due to tumor lysis. Pain relief was possible. Control CT scans three months after percutaneous RFA revealed shrinkage of the treated tumor nodules. Percutaneous RFA was successfully performed in three patients. CT-guided percutaneous RFA of non-resectable lung neoplasms may be a complement to chemotherapy and radiation therapy. Further clinical experience and prospective studies are needed to determine the long-term efficacy and safety of RFA in the treatment of lung tumors.