PMC5586794_01
a Photograph of the proband case with bilateral pedal edema. b Family pedigree showing affected individuals (arrow showing the proband case).
mpp-0022-0593-g01.jpg
PMC5586794_01_mpp-0022-0593-g01.jpg
F1
General examination revealed bilateral nonpitting pedal edema up to mid calves (fig. 1a). A detailed family pedigree was charted, as far as the 4th generation (fig. 1b).
Anterior lymphoscintigram obtained 1 h after the injection of radionuclide distally in the feet (bottom arrowheads). Left panel shows a normal study with a symmetric uptake in the ilioinguinal lymph nodes (arrow). Right panel shows an abnormal study with little or no lymphatic drainage (uptake) in the proximal inguinal lymph nodes (top arrowhead), suggestive of failure of lymphatic drainage, as in our patient.
mpp-0022-0593-g02.jpg
PMC5586794_01_mpp-0022-0593-g02.jpg
F2
There was evidence of decreased uptake of radioactive tracer in proximal lymph nodes (inguinal nodes), suggesting impaired lymphatic drainage in the lower extremities (fig. 2).