Lymphangiography

Definition

Lymphangiography, or lymph node angiogram, is a test which utilizes x-ray technology, along with the injection of a contrast agent, to view lymphatic circulation and lymph nodes for diagnostic purposes.

Purpose

The lymphatic system is a one way circulation that channels tissue fluid back into the heart. The watery fluid called lymph seeps out of the blood into tissues, and while journeying back to the heart, it picks up germs, cancer cells, and some waste products. Lymph passes through the lymph nodes, which are major arsenals of immune defense that attack germs carried in the lymph. Cancer cells are also subject to attack in lymph nodes.

Cancers of the lymph system, such as Hodgkin's disease and non-Hodgkin's lymphomas, spread throughout the body. Treatment often depends upon finding all the disease and directing radiation to each location. Planning other kinds of treatment, such as surgery or chemotherapy, may also require that the full extent of the disease be known.

The lymphatic circulation may become clogged by infection, injury, or several other types of cancer that have spread through lymphatic channels. Swelling, sometimes massive, can result from blocked lymphatics. The most outstanding example of this is the tropical disease filariasis, which results in the swelling of the legs termed elephangiasis.

Lymphangiography gives precise information on the extent and location of lymph vessels and lymph nodes. Oftentimes, it is performed to evaluate the extent of a lymphatic cancer. Rarely, it is a tool, which aids surgeons attempting to reconstruct the lymphatics.

Precautions

Lymphangiography should not be performed on patients with dye or shellfish allergies or on patients with chronic lung disease, kidney disease, heart disease, or liver disease.

Description

A lymphangiogram begins by injecting a blue dye into a hand or foot. The lymph system picks up dye, which in turn will highlight the lymph vessels. This process may take a full day. When the lymphatic channel is clearly visible, the radiologist will insert an even tinier needle into that vessel and inject a contrast agent. X rays outline the journey of the contrast agent as it travels to the heart through lymph vessels and nodes.

Preparation

Unless a dye allergy is suspected, no special preparation is need. If an allergy is suspected, a non-ionic contrast agent can be administered instead.

Aftercare

Prior to suture removal seven to 10 days after the procedure, the patient should watch for any sign of infection around the site.

Risks

Lipid pneumonia can occur if the contrast agent penetrates the thoracic duct. An allergic reaction to the contrast agent is possible, causing a range of symptoms that can range from innocuous to life threatening.

Key Terms

Contrast agent

A substance that makes shadows on x rays.

Filariasis

A tropical disease caused by worms that live in lymph channels.

Hodgkin's disease

A cancer of the lymphatic system.

Lymphoma

A type of lyphatic cancer.

For Your Information

Books

• Merrill, Vinta. "Lymphangiography." In Atlas of Roentgenographic Positions and Standard Radiologic Procedures. Saint Louis: The C. V. Mosby Co., 1975.

Sources: Gale Encyclopedia of Medicine, Published December, 2002 by the Gale Group

The Essay Author is J. Ricker Polsdorfer MD.