I often describe them to patients as like a bunch of grapes. You can see each grape, and that has therapeutic implications because if they're full of fluid the size of a grape, you can imagine sticking a needle in, sucking out the fluid, and instilling a sclerosis.
I have become a passionate advocate of enter inhibition to determine whether or not interventional therapies, whether they be with a needle or a knife, are necessary.
opinionUsing incorrect terminology like cystic hygroma and lymphangioma causes confusion among clinicians, colleagues, and patients↗
▶Ep 8 · 5:01
quoteIf we use the wrong names, we confuse ourselves, we confuse our colleagues, and we confuse our patients.↗
▶Ep 8 · 5:43
clinicalMacrocystic lymphatic malformations can be described to patients as like a bunch of grapes where each grape is visible and can be accessed with a needle for sclerotherapy↗
▶Ep 8 · 5:54
quoteI often describe them to patients as like a bunch of grapes. You can see each grape, and that has therapeutic implications because if they're full of fluid the size of a grape, you can imagine sticking a needle in, sucking out the fluid, and instilling a sclerosis.↗
▶Ep 8 · 6:14
clinicalMicrocystic lesions are like a small porous sponge with cysts too tiny to see individually, making sclerotherapy less practical↗
▶Ep 8 · 9:06
clinicalMost lymphatic malformations are present at birth and visible at birth, though some may present later with sudden expansion↗
▶Ep 8 · 10:05
clinicalThere are four general treatment options for lymphatic malformations: observation with reassurance, microinterventional therapy with needle or catheter, resective surgery, and pharmacological therapy↗
▶Ep 8 · 10:12
quoteThese are not cancers. They're often not dangerous, and we talk about the risks of doing nothing or the risk of intervention.↗
▶Ep 8 · 12:30
opinionFor very large truncal lesions extending from axilla to pelvis, surgical resection may be preferred over multiple sclerotherapy sessions to avoid significant radiation exposure and potentially unsatisfactory outcomes from residual tissue↗
▶Ep 8 · 18:32
quoteI have become a passionate advocate of enter inhibition to determine whether or not interventional therapies, whether they be with a needle or a knife, are necessary.↗
▶Ep 8 · 19:31
clinicalOperating on patients while continuing sirolimus makes tissue softer, allows easier elevation of skin flaps, and enables more extensive resection with better closure compared to operating without the medication↗
▶Ep 8 · 20:25
opinionSirolimus is unlikely to be useful for purely macrocystic lesions, and the tissue expansion effect from large cysts can actually make surgery easier↗
▶Ep 8 · 22:33
epidemiologicalSpontaneous resolution of macrocystic lymphatic malformations occurs in less than a handful of cases out of several thousand patients↗
▶Ep 8 · 23:27
clinicalEXIT procedures are not really necessary for lymphatic lesions because they are soft and compressible, allowing intubation, unlike firm teratomas↗
▶Ep 8 · 24:46
quoteSir, I'm really sorry that I was wrong, but I'm really glad I was wrong. I said this is a great outcome.↗
▶Ep 8 · 25:11
clinicalBabies with congenital lymphedema of the lower extremities can have regression to the point of non-detection on physical exam, though this is uncommon↗
▶Ep 8 · 25:55
clinicalFor lesions impinging on the airway that could cause emergency if infected or bleeding occurs, observation is not a good option↗
▶Ep 8 · 26:09
opinionEarly treatment in infancy is now preferred for microcystic lesions on the face, tongue, and floor of mouth, with medical therapy rather than surgery↗
▶Ep 8 · 29:28
quotePat Burroughs used to say, you know, if it's not classic history, physical, and imaging, you need to get tissue.↗
▶Ep 8 · 29:28
guidelineBurroughs rule states that if diagnosis is not classic on history, physical, and imaging, tissue biopsy is necessary↗
▶Ep 8 · 34:25
clinicalA small amount of ethanol systemically can cause sudden fatal pulmonary hypertension↗
▶Ep 8 · 34:25
quoteA small amount of ethanol systemically can cause sudden fatal pulmonary hypertension.↗
▶Ep 8 · 34:45
clinicalLarge venous anomalies with direct macroscopic outflow to systemic veins can result in pulmonary embolism from clot induced by sclerotherapy↗
▶Ep 8 · 34:59
clinicalVenous mapping by MR, ultrasound, or venography is essential before sclerotherapy, and direct venous outflow must be obliterated first using laser, coils, or glue to prevent fatal pulmonary embolism↗
▶Ep 8 · 35:45
quoteIt's fatal. And like I always say, don't ask me how I know.↗
▶Ep 8 · 37:12
epidemiologicalMost sclerotherapy worldwide is likely performed by surgeons rather than interventional radiologists because many countries lack image-guided fluoroscopy suites↗
▶Ep 8 · 39:38
clinicalPatients with central conducting lymphatic anomalies can present with subcutaneous chyle, eroding bones, chylous ascites, chylothorax, and chyle dripping from urethra, scrotum, vagina, or even from under toenails↗
