Fig 8. “Intra-abdominal LNs and collateral vessels are shown in a case of secondary LLLE!”.

Phase 3 lymphoscintigraphy [left: Anterior WBS obtained after 1 hour of walking [phase 3] at the end of our exam] revealed in a 59-year-old man with left-sided LLLE secondary to surgery and radiotherapy for liposarcoma of the thigh the following:

• On the right side, multiple draining LVs reaching one complete infra-diaphragmatic LN axis were observed.
• On the left side, lymphatic drainage from the ankle to the root of the limb through the superficial dermal lymphatic network was observed with one inguinal LN, one inguinocrural LN and at least one upper iliac common LN with one left-sided group of lumbo-aortic LNs [which might have received their colloidal load from the right-sided LNs].

The three sets of consecutive images [from top to bottom, anterior views on the right and posterior views on the left] centered on the pelvis and abdomen obtained after the intradermal injection performed on the same day in the external part of the buttock revealed the following:

• On the posterior views, one LV flowing “up” reaching two external iliac LNs [oblique arrows] above the inguinocrural LN was observed, along with another LV flowing “down” posteriorly [vertical arrow] toward the internal part of the thigh to reach the superficial dermal lymphatic network.
• On the anterior views, one faintly active LV [vertical arrow] flowing toward the midline under the area of bladder activity was observed.