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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
- Supplanted by cross-sectional imaging
- 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
- Key component of immune system
- 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
- Lymphatic capillaries in soft tissues
- 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
- Lymphography: Radiopaque contrast injection into lymphatic vessel(s) to visualize lymphatic structures
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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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
- Supplanted by cross-sectional imaging
- 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
- Key component of immune system
- 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
- Lymphatic capillaries in soft tissues
- 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
- Lymphography: Radiopaque contrast injection into lymphatic vessel(s) to visualize lymphatic structures
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
