Is mannitol combined with furosemide a new treatment for refractory lymphedema? A case report

Figure 1 Change in brain computed tomography during hospitalization. A: Brain computed tomography (CT) at admission. Intracranial hemorrhage in the parieto-occipital lobe was confirmed, and midline shift was observed due to brain edema; B: Brain CT on the 8^th hospital day. Intracranial hemorrhage persists and concomitant Intra-ventricular hemorrhage (IVH) is confirmed; C: Brain CT on the 17^th hospital day. Intracranial hemorrhage has begun to resolve and improvement of IVH is shown; D: Brain CT on the 28^th hospital day. Intracranial hemorrhage shows ongoing resolution, and brain edema has also decreased; E: Brain CT on the 57^th hospital day. Improvement in brain edema has resulted in dilatation of the ventricle and resolution of midline shift; F: Brain CT on the 82^nd hospital day. Encephalomalacic change in the left parietal lobe is confirmed, and there is no evidence of new intracranial hemorrhage.

Figure 2 Change of circumference of the left lower leg before and after administration of mannitol and furosemide. After the patient received mannitol and furosemide from the 1^st to the 27^th hospital day, the left lower extremity lymphedema improved dramatically. The improved lymphedema was also identified after re-administration of mannitol and furosemide from the 52^th to the 58^th hospital day. HD: Hospital day.

Figure 3 Changes in lymphedema during the hospital day. A: After discontinuation of mannitol and furosemide (on the 49^th hospital day); B: Improved lymphedema after reinstatement of mannitol and furosemide (on the 61^st hospital day).