Lymphography

Lymphography: Lymph/o: Lymph / -graphy:………

Invasive procedure Oil base contrast (the radiographic one) Uses gross-visualized dye contrast and

radiopaque contrast Lymphogram is the term used to cover

both lymph vessels and lymph nodes’ studies: lymphangiography and lymphadenography

Basics of the Lymphatic System

Returns proteins and fluid that has leaked out of the bloodstream back into the blood

Relates to the immune system. Lymphocytes and monocytes

The Lymphatic system is divided in lymph nodes, lymph vessels and lymph capillaries

Lymph Nodes

Most common and largest clusters of lymph nodes: Cervical Axillary Mediastinal And inguinal (groin) Note: tonsils are masses of lymph

tissue. Note: adenoids are enlarged lymph

tissue in the nasopharynx.

ProcedureA violet color dye is injected subcutaneously between 1st and 2nd interdigital spaces, foot or hand.

The dye works as a tracer to find the lymph vessels

One incision is made on the superior aspect of injected foot, or posterior aspect of the injected hand.

Procedure

The incision should be just big enough to access the tinted lymph vessels (visualized thanks to the violet dye)

The injection of radiographic oil-base contrast is done trough the uncovered lymph vessels

The injection takes about 30 min. using a 27 or 30 gauge needle

Procedure

Confirmation of injection in the lymphatic system could be done with fluoroscopy

The first radiograph is taken 1 hr after injection, to visualize only lymph vessels

Lymph Nodes radiographs are taken 24 hrs after injection.

Lymph nodes retain contrast for 3 to 4 weeks

Procedure

Abnormal physiology may retain contrast for months

Delayed films may be required

The violet coloration can be observed on skin and urine and it usually disappear within a few hrs after injection.

Lymphatic System

Alternative Exams and Indications

MRI and CT have replaced this procedure almost completely. However, lymphography is useful evaluating extent of lymphomas and staging of radiation. Also, demonstrating obstructions of lymph vessels and others.