Postoperative Lymphoceles Can Present with Internal Septations
Yes, postoperative lymphoceles frequently demonstrate internal septations on imaging, and this feature actually helps distinguish them from other postoperative fluid collections. 1
Imaging Characteristics of Lymphoceles
According to the American College of Radiology guidelines, lymphoceles more often have septa than other postoperative fluid collections such as hematomas, urinomas, or abscesses. 1 This septated appearance is a characteristic imaging feature that can aid in diagnosis, though it is not pathognomonic.
Key Distinguishing Features:
- Septations are common in lymphoceles and help differentiate them from other collections 1
- Timing matters: Lymphoceles typically occur weeks to months after surgery, whereas hematomas, urinomas, and abscesses appear in the early postoperative period 1
- Hematomas tend to have higher echogenicity on ultrasound compared to lymphoceles 1
Clinical Context
Lymphoceles develop after extensive pelvic lymphadenectomies, including:
- Radical prostatectomy with pelvic lymph node dissection 2, 3
- Renal transplantation 1
- Gynecologic surgeries 4, 3
Important Caveat:
While septations suggest lymphocele, ultrasound cannot reliably differentiate between abscess, hematoma, urinoma, and lymphocele based on imaging alone. 1 Definitive diagnosis requires aspiration with biochemical and cytologic analysis of the fluid. 1, 4
Diagnostic Approach
When evaluating a postoperative pelvic fluid collection:
- Assess timing: Collections appearing weeks to months postoperatively favor lymphocele 1
- Look for septations: Their presence supports (but does not confirm) lymphocele 1
- Perform aspiration: This is the gold standard for definitive diagnosis, typically done under ultrasound guidance 1, 4
- Analyze fluid: Biochemical and cytologic findings confirm the diagnosis 4