Seromas and Lymphoceles
A seroma is a collection of clear serous fluid that sometimes develops in the body after surgery or an injury. This fluid is made up of blood plasma that has seeped out of injured small blood vessels and fluid produced by injured and dying cells. This fluid is not infectious and the body is usually able to reabsorb them. If not, and/or the seroma is causing symptoms (pain. fullness), it may be beneficial to have a drainage catheter placed.
A lymphocele is a collection of fluid from the lymphatic system. It is usually a surgical complication seen after surgeries such as lymph node removal and pelvic surgery. Spontaneous development is rare. Many are asymptomatic but can complicate by becoming infected, cause obstructions or blockages, venous fistulas or ascites.
What do we do about them?
Most seromas and lymphoceles are asymptomatic. They can be incidentally found on post-surgical imaging. Depending on the size and symptoms, they may not require treatment and resolve on their own. However, if they are symptomatic or there is concern that the fluid might be infected, then it may require drainage or surgery.
How do we treat them?
In Interventional Radiology we use ultrasound or CT guidance to guide placement of a needle and sometimes a small drainage catheter into the seroma or lymphocele. For small collections, aspiration of the fluid with a small needle is only needed, but in larger collections, a small drainage catheter may need to remain in place to allow continual drainage for a few days, up to a few weeks. For some seromas, they may require sclerosis where a sclerotic agent such as alcohol or betadine is injected through the catheter to help break apart some of the wall surrounding the seroma to help it collapse and prevent recurrence.
What are the risks?
Image guidance not only guides placement of a drainage tube, but it also helps avoid inadvertent injury to normal structures deep within the body such as major arteries or veins, organs and bowel. Still, there is a small risk of bleeding or organ injury despite the most careful drain placement.
As stated above, seromas or lymphoceles may reoccur and could require multiple drainages and/or a drain placement.
How is the procedure done?
The procedure is performed under ultrasound or CT guidance. Depending on the depth and location of the seroma or lymphocele it may be done in the clinic or at the hospital as an outpatient procedure. In some cases you may be given intravenous medications for pain relief and to treat anxiety. These medications cause moderate or “twilight” sedation. If necessary, the procedure area will be shaved. The skin will then be sterilized with a special liquid, covered with sterile drapes, and the skin will be locally anesthetized with an injection of Lidocaine. This injection may cause some burning but shortly thereafter the area will be numb. Then, image-guided insertion of a needle with a small drain will be placed into the fluid collection. The fluid will then be aspirated out and based on the volume of fluid drawn off, the drain may be left in place. Through this drain a sclerosant agent may be injected to try and break down the scar tissue and help overall shrink the fluid collection space. If a drain is left in place then it will be secured to your skin with a small suture and an adhesive bandage and connected to a collection bulb. If a drain is not left in place then the puncture site will be sealed with skin glue.
What can you expect after the procedure?
If your procedure was done in the hospital with moderate sedation then you will go to recovery for about 1 hour where your blood pressure, heart rate and oxygen are monitored. While here you will be able to eat, drink and see your family and friends who accompanied you. If you have a drain placed, you will be taught how to care for your drain and will follow-up with us in the clinic in the coming days.
If your procedure was not done in the hospital and/or you did not receive any sedation you will be able to go home about 30 minutes after your procedure. If you have a drain placed, you will be taught how to care for your drain and will follow-up with us in the clinic in the coming days.
What should I watch for?
You may be sore after the procedure. However, the pain should not get worse and should subside in 2-3 days. If you develop severe pain or if there is substantial bleeding you should seek immediate medical attention at your closest emergency room. If pain seems to be getting gradually worse, if you develop new fevers or chills, or if the drain becomes dislodged you can call us at (650) 404-8445 Monday thru Friday between 8am-5pm, or reach the on-call Interventional Radiologist by calling (408) 739-6000.
Home care of your catheter (if one was placed):
The important aspects of home catheter care are summarized in “My Drainage Catheter.” Essentially, you should be sure the catheter is draining, and for some people we recommend daily flushing of the catheter with a syringe. If there is a suction bulb, it should be properly set up to apply suction. Daily drainage and your daily temperature need to be recorded. This daily recording should be brought with you to your clinic visit. You should call (650) 404-8445 when you are discharged from the hospital to arrange this clinic visit.
If you received sedation on the day you were treated, you should not drive, consume alcohol, operate heavy machinery or make any important decisions for the remainder of the day.
You may resume your regular activities (including driving) after 24 hours, unless you have been restricted for another reason.
No exercising, lifting heavy objects or strenuous activity for the next 24 hours.
You may shower 24 hours after the procedure. Just make sure the dressing site is dry afterwards.
You may use over the counter medication such as Acetaminophen (Tylenol) or ibuprofen (Advil /Motrin) for minor discomfort, unless you are restricted from taking these medications.
If you feel that Tylenol or Advil are not enough for pain control, please contact the Vascular and Interventional Radiology Clinic at 650-404-8445.
You can resume your normal diet. Therefore light meals are recommended until you know that you can eat without problems.