Lymphography: Radiopaque contrast injection into lymphatic vessel(s) to visualize lymphatic structures
Historically used to assess lymph nodes/lymphatics
Now infrequently performed
Supplanted by cross-sectional imaging
Imaging lymphatic system remains challenging
Invasive, time-consuming procedure
Lost art; technically difficult
Lymphangiography: Synonym for lymphography
Lymphatic system
Key component of immune system
Lymphocyte, plasma cell, mastocyte production
Transports immune cells
Includes structures involved in lymphocyte circulation/production: Bone marrow, lymphoid tissue of digestive system, lymphatic vessels, spleen, thymus
Involved in fluid transport/regulation in body
Absorbs intestinal fatty acids from lacteals
Transports chyle/lymph
Lymphatic contraction, 1-way valves promote flow through lymphatic system
Returns interstitial proteins to blood
Provides filtration of fluids through lymph nodes
Lymphatic anatomy
Lymphatic capillaries in soft tissues
Coalesce to form lymphatic vessels
Lower extremity lymphatics combine in pelvis
Form internal and external iliac lymphatic chains
Common iliac lymphatics join to form paraaortic and paracaval lymphatic chains
Paraaortic and paracaval chains join to form cisterna chyli and thoracic duct
Cisterna chyli
Fusiform, sac-like outpouching formed by confluence of lymphatic channels
Usually located along right posterior aspect of abdominal aorta
Variable location relative to vertebral level
T12-L2 level most frequently
May not be present
Caudal origin of thoracic duct
Thoracic duct
Common drainage pathway of lymphatic system from abdomen, pelvis, lower extremities, left upper extremity
Carries 2-4 L of lymph daily
Proteins, lipids, lymphocytes
Originates at cisterna chyli
Courses superiorly in thoracic cavity
Extends from cisterna chyli level to base of neck
Right of midline; crosses to left at T5-T6
Posterior to esophagus
Drains into confluence of left subclavian/internal jugular vein
May have multiple channels, variations, duplication
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Procedure Steps
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
OUTCOMES
Problems
Complications
Expected Outcome
Selected References
Klotz R et al: Therapeutic lymphography for persistent chyle leak after pancreatic surgery. HPB (Oxford). 24(5):616-23, 2022
Cellina M et al: Non-contrast MR lymphography of lipedema of the lower extremities. Magn Reson Imaging. 71:115-24, 2020
Riley LE et al: Clinical approach and review of causes of a chylothorax. Respir Med. 157:7-13, 2019
Sheybani A et al: Cerebral embolization of ethiodized oil following intranodal lymphangiography. Semin Intervent Radiol. 32(1):10-3, 2015
Kariya S et al: Intranodal lymphangiogram: technical aspects and findings. Cardiovasc Intervent Radiol. 37(6):1606-10, 2014
Nadolski GJ et al: Feasibility of ultrasound-guided intranodal lymphangiogram for thoracic duct embolization. J Vasc Interv Radiol. 23(5):613-6, 2012
Cooper K et al: Positron emission tomography (PET) and magnetic resonance imaging (MRI) for the assessment of axillary lymph node metastases in early breast cancer: systematic review and economic evaluation. Health Technol Assess. 15(4):1-134, 2011
Deso S et al: Lymphangiography in the diagnosis, localization, and treatment of a lymphaticopelvic fistula causing chyluria: a case report. Vasc Endovascular Surg. 44(8):710-3, 2010
Lu Q et al: Chronic lower extremity lymphedema: a comparative study of high-resolution interstitial MR lymphangiography and heavily T2-weighted MRI. Eur J Radiol. 73(2):365-73, 2010
Plotnik AN et al: How I do it: Lymphangiography. J Med Imaging Radiat Oncol. 54(1):43-6, 2010
Small W Jr et al: A prospective trial comparing lymphangiogram, cross-sectional imaging, and positron emission tomography scan in the detection of lymph node metastasis in locally advanced cervical cancer. Am J Clin Oncol. 33(1):89-93, 2010
Narayanan P et al: Magnetic resonance lymphography: a novel technique for lymph node assessment in gynecologic malignancies. Cancer Biomark. 5(2):81-8, 2009
Notohamiprodjo M et al: MR-lymphangiography at 3.0 T--a feasibility study. Eur Radiol. 19(11):2771-8, 2009
Guermazi A et al: Lymphography: an old technique retains its usefulness. Radiographics. 23(6):1541-58; discussion 1559-60, 2003
Witte CL et al: Advances in imaging of lymph flow disorders. Radiographics. 20(6):1697-719, 2000
North LB et al: Lymphography for staging lymphomas: is it still a useful procedure? AJR Am J Roentgenol. 161(4):867-9, 1993
Sachs PB et al: Diagnosis and localization of laceration of the thoracic duct: usefulness of lymphangiography and CT. AJR Am J Roentgenol. 157(4):703-5, 1991
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Preprocedure
Procedure
TERMINOLOGY
Definitions
Lymphography: Radiopaque contrast injection into lymphatic vessel(s) to visualize lymphatic structures
Historically used to assess lymph nodes/lymphatics
Now infrequently performed
Supplanted by cross-sectional imaging
Imaging lymphatic system remains challenging
Invasive, time-consuming procedure
Lost art; technically difficult
Lymphangiography: Synonym for lymphography
Lymphatic system
Key component of immune system
Lymphocyte, plasma cell, mastocyte production
Transports immune cells
Includes structures involved in lymphocyte circulation/production: Bone marrow, lymphoid tissue of digestive system, lymphatic vessels, spleen, thymus
Involved in fluid transport/regulation in body
Absorbs intestinal fatty acids from lacteals
Transports chyle/lymph
Lymphatic contraction, 1-way valves promote flow through lymphatic system
Returns interstitial proteins to blood
Provides filtration of fluids through lymph nodes
Lymphatic anatomy
Lymphatic capillaries in soft tissues
Coalesce to form lymphatic vessels
Lower extremity lymphatics combine in pelvis
Form internal and external iliac lymphatic chains
Common iliac lymphatics join to form paraaortic and paracaval lymphatic chains
Paraaortic and paracaval chains join to form cisterna chyli and thoracic duct
Cisterna chyli
Fusiform, sac-like outpouching formed by confluence of lymphatic channels
Usually located along right posterior aspect of abdominal aorta
Variable location relative to vertebral level
T12-L2 level most frequently
May not be present
Caudal origin of thoracic duct
Thoracic duct
Common drainage pathway of lymphatic system from abdomen, pelvis, lower extremities, left upper extremity
Carries 2-4 L of lymph daily
Proteins, lipids, lymphocytes
Originates at cisterna chyli
Courses superiorly in thoracic cavity
Extends from cisterna chyli level to base of neck
Right of midline; crosses to left at T5-T6
Posterior to esophagus
Drains into confluence of left subclavian/internal jugular vein
May have multiple channels, variations, duplication
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Procedure Steps
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
OUTCOMES
Problems
Complications
Expected Outcome
Selected References
Klotz R et al: Therapeutic lymphography for persistent chyle leak after pancreatic surgery. HPB (Oxford). 24(5):616-23, 2022
Cellina M et al: Non-contrast MR lymphography of lipedema of the lower extremities. Magn Reson Imaging. 71:115-24, 2020
Riley LE et al: Clinical approach and review of causes of a chylothorax. Respir Med. 157:7-13, 2019
Sheybani A et al: Cerebral embolization of ethiodized oil following intranodal lymphangiography. Semin Intervent Radiol. 32(1):10-3, 2015
Kariya S et al: Intranodal lymphangiogram: technical aspects and findings. Cardiovasc Intervent Radiol. 37(6):1606-10, 2014
Nadolski GJ et al: Feasibility of ultrasound-guided intranodal lymphangiogram for thoracic duct embolization. J Vasc Interv Radiol. 23(5):613-6, 2012
Cooper K et al: Positron emission tomography (PET) and magnetic resonance imaging (MRI) for the assessment of axillary lymph node metastases in early breast cancer: systematic review and economic evaluation. Health Technol Assess. 15(4):1-134, 2011
Deso S et al: Lymphangiography in the diagnosis, localization, and treatment of a lymphaticopelvic fistula causing chyluria: a case report. Vasc Endovascular Surg. 44(8):710-3, 2010
Lu Q et al: Chronic lower extremity lymphedema: a comparative study of high-resolution interstitial MR lymphangiography and heavily T2-weighted MRI. Eur J Radiol. 73(2):365-73, 2010
Plotnik AN et al: How I do it: Lymphangiography. J Med Imaging Radiat Oncol. 54(1):43-6, 2010
Small W Jr et al: A prospective trial comparing lymphangiogram, cross-sectional imaging, and positron emission tomography scan in the detection of lymph node metastasis in locally advanced cervical cancer. Am J Clin Oncol. 33(1):89-93, 2010
Narayanan P et al: Magnetic resonance lymphography: a novel technique for lymph node assessment in gynecologic malignancies. Cancer Biomark. 5(2):81-8, 2009
Notohamiprodjo M et al: MR-lymphangiography at 3.0 T--a feasibility study. Eur Radiol. 19(11):2771-8, 2009
Guermazi A et al: Lymphography: an old technique retains its usefulness. Radiographics. 23(6):1541-58; discussion 1559-60, 2003
Witte CL et al: Advances in imaging of lymph flow disorders. Radiographics. 20(6):1697-719, 2000
North LB et al: Lymphography for staging lymphomas: is it still a useful procedure? AJR Am J Roentgenol. 161(4):867-9, 1993
Sachs PB et al: Diagnosis and localization of laceration of the thoracic duct: usefulness of lymphangiography and CT. AJR Am J Roentgenol. 157(4):703-5, 1991
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