{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T01:13:54Z","timestamp":1787793234779,"version":"build-2784847793"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T00:00:00Z","timestamp":1624492800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T00:00:00Z","timestamp":1624492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To characterize hepatic to systemic lymphatic connections in patients with systemic lymphatic disease using intra-hepatic lymphangiography and to compare outcomes after lymphatic intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this retrospective study, patients with intra-hepatic lymphangiography from May 2014 \u2013 April 2019 at our institution were included. Imaging review was performed and hepatic lymphatic connections and flow patterns were characterized. Clinical data were reviewed and comparisons between patients undergoing lymphatic intervention with or without abnormal hepatic lymphatics were performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the study period, 105 patients underwent intra-hepatic lymphangiography. Primary clinical presentation included ascites (19\/105), chylothorax (27\/105), plastic bronchitis (PB) (17\/105), and protein losing enteropathy (PLE) (42\/105). Five categories of hepatic lymphatic connections and flow patterns were identified (%): normal (25%, 26\/105), hepatoperitoneal (12%, 13\/105), hepatopulmonary (10.5%, 11\/105), hepatomesenteric (7.5%, 8\/105), and hepatoduodenal (41%, 43\/105) with four patients having more than one abnormal pattern. A comparison between clinical presentation and imaging category revealed an increased likelihood of having ascites with hepatoperitoneal (<jats:italic>p<\/jats:italic>&lt; .0001), chylothorax\/PB with hepatopulmonary (<jats:italic>p<\/jats:italic>= .01), and PLE with hepatoduodenal (<jats:italic>p<\/jats:italic>&lt; .001) connections. Seventy-six patients had a lymphatic intervention, 24% with normal, and 76% with abnormal liver lymphatics. There was no difference in length of hospital stay or mortality between the two groups, but there was a prolonged time to symptom resolution (<jats:italic>p<\/jats:italic>= .006) and persistent symptoms after 6\u00a0months (5% vs 44%,<jats:italic>p<\/jats:italic>= .002) in the group with abnormal liver lymphatics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We identified five liver lymphatic imaging categories with a substantial correlation to presenting lymphatic disease. Abnormal imaging patterns correlated with increased morbidity. Evaluation of liver lymphatics should be considered in patients with a systemic lymphatic disease if central lymphatic imaging is normal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Points<\/jats:title><jats:p>\u2022<jats:italic>We identified five liver lymphatic imaging patterns: normal, hepatoperitoneal, hepatomesenteric, hepatopulmonary, and hepatoduodenal.<\/jats:italic><\/jats:p><jats:p>\u2022<jats:italic>Imaging patterns were correlated with disease presentation (normal \u2013 chylothorax\/PB, hepatoperitoneal \u2013 ascites\/chylothorax, hepatopulmonary \u2013 chylothorax\/PB, hepatoduodenal \u2013 PLE).<\/jats:italic><\/jats:p><jats:p>\u2022<jats:italic>Abnormal imaging patterns correlated with increased morbidity.<\/jats:italic><\/jats:p><\/jats:sec>","DOI":"10.1007\/s00330-021-08098-z","type":"journal-article","created":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T10:02:36Z","timestamp":1624528956000},"page":"112-121","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Liver lymphatic anatomy and role in systemic lymphatic disease"],"prefix":"10.1007","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3837-8338","authenticated-orcid":false,"given":"Christopher L.","family":"Smith","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandi","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhumitha","family":"Saravanan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron G.","family":"Dewitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Biko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin M.","family":"Pinto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando A.","family":"Escobar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ganesh","family":"Krishnamurthy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jefferson N.","family":"Brownell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petar","family":"Mamula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew C.","family":"Glatz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Gillespie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael L.","family":"O\u2019Byrne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chitra","family":"Ravishankar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan J.","family":"Rome","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoav","family":"Dori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,6,24]]},"reference":[{"key":"8098_CR1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/S0169-409X(01)00150-8","volume":"50","author":"MA Swartz","year":"2001","unstructured":"Swartz MA (2001) The physiology of the lymphatic system. 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These were our original small case series\/technique papers describing intrahepatic MRL and intramesenteric MRL, and a small case series from our original description of PLE\u00a0(reference [], 20, and\u00a0European Radiology 2020 Oct;30(10):5777\u20135784). Together these papers had 29 patients, which is a much smaller number of patients than\u00a0this study that includes 105 patients.\u00a0In addition, this study is a more comprehensive description of liver lymphangiography by expanding on these techniques to describe this larger and broader\u00a0patient population and correlates both pathologic patterns with disease presentation as well as disease outcome after intervention\u00a0that has not been previously described.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"value":"\u2022 retrospective\u2022 observational\u2022 performed at one institution","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}