fig7

Figure 7. Case 2. A 92-year-old woman with primary lymphedema in the left leg and chylous pleural effusion. (A) Clinical picture at the first consultation. Severe edema can be observed in the left leg, especially in the thigh; (B) Lymphoscintigram; (C) Lymphatic ultrasonographic finding in the left thigh; (D) Intraoperative finding during lymphaticovenous anastomosis (LVA) in the left thigh. Milky discharge, which seems to be a reflux from the intestinal lymph, is observed; (E) Intraoperative finding during LVA. V indicates a vein and L indicates a lymphatic vessel; (F) Clinical picture after LVA and compression therapy. Edema in the left lower extremity has improved; (G) Findings immediately after excision of excess skin and adipose tissue in the left thigh; (H) Clinical picture a few months after the surgery. (A,F,G^[52]).