Lymphography is a medical imaging technique in which a

radiocontrast Radiocontrast agents are substances used to enhance the visibility of internal structures in X-ray-based imaging techniques such as computed tomography ( contrast CT), projectional radiography, and fluoroscopy. Radiocontrast agents are typically i ...

agent is injected, and then an

X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...

picture is taken to visualise structures of the lymphatic system, including lymph nodes, lymph ducts,

lymphatic tissues The lymphatic system, or lymphoid system, is an organ system in vertebrates that is part of the immune system, and complementary to the circulatory system. It consists of a large network of lymphatic vessels, lymph nodes, lymphatic or lymphoid ...

lymph capillaries Lymph capillaries or lymphatic capillaries are tiny, thin-walled microvessels located in the spaces between cells (except in the central nervous system and non-vascular tissues) which serve to drain and process extracellular fluid. Upon enteri ...

and lymph vessels. Lymphangiography is the same procedure, used only to visualize the lymph vessels. The x-ray film or image of the

lymphatic vessels The lymphatic vessels (or lymph vessels or lymphatics) are thin-walled vessels (tubes), structured like blood vessels, that carry lymph. As part of the lymphatic system, lymph vessels are complementary to the cardiovascular system. Lymph vessel ...

and

lymph nodes A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that inclu ...

is called a lymphogram or a lymphangiogram. Radiographs can be taken after injection of a

radiopaque Radiodensity (or radiopacity) is opacity to the radio wave and X-ray portion of the electromagnetic spectrum: that is, the relative inability of those kinds of electromagnetic radiation to pass through a particular material. Radiolucency or hypod ...

contrast medium into small lymphatic vessels (these are made visible by prior subcutaneous injection of patent blue dye). The resulting lymphogram is used to find the locations of large vessels and nodes, and to identify sites of blockage in lymphatic drainage. Lymph nodes can also be detected via radionuclide imaging after injection of radioactive colloids. Macrophages

phagocytose Phagocytosis () is the process by which a cell uses its plasma membrane to engulf a large particle (≥ 0.5 μm), giving rise to an internal compartment called the phagosome. It is one type of endocytosis. A cell that performs phagocytosis is ...

these foreign bodies and sequester in the nodes.

Use

Lymphography is used to visualise the structures of the lymphatic system, including lymph nodes, lymph ducts,

and lymph vessels. It can be used during thoracic duct embolisation. Lymphography is not commonly used in modern medicine since the adoption of CT scan and

PET scan Positron emission tomography (PET) is a functional imaging technique that uses radioactive substances known as radiotracers to visualize and measure changes in metabolic processes, and in other physiological activities including blood flow, ...

technologies.

Risks

Lymphograhy is usually considered a very safe procedure. The most serious adverse reaction tends to be a possible

allergic reaction Allergies, also known as allergic diseases, refer a number of conditions caused by the hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include hay fever, food allergies, atopic derma ...

to injected

contrast agent A contrast agent (or contrast medium) is a substance used to increase the contrast of structures or fluids within the body in medical imaging. Contrast agents absorb or alter external electromagnetism or ultrasound, which is different from radiop ...

. Lymphography is often an invasive procedure. It may be difficult to access

, as they are usually very narrow and hard to locate. The procedure also takes a very long time to perform.

Technique

A needle or

catheter In medicine, a catheter (/ˈkæθətər/) is a thin tubing (material), tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgi ...

is inserted into a

lymphatic vessel The lymphatic vessels (or lymph vessels or lymphatics) are thin-walled vessels (tubes), structured like blood vessels, that carry lymph. As part of the lymphatic system, lymph vessels are complementary to the cardiovascular system. Lymph ve ...

in either the foot or the

arm In human anatomy, the arm refers to the upper limb in common usage, although academically the term specifically means the upper arm between the glenohumeral joint (shoulder joint) and the elbow joint. The distal part of the upper limb between th ...

. A

is injected into the lymphatic vessel. This may be around 2 to 4

millilitres The litre (international spelling) or liter (American English spelling) (SI symbols L and l, other symbol used: ℓ) is a metric unit of volume. It is equal to 1 cubic decimetre (dm3), 1000 cubic centimetres (cm3) or 0.001 cubic metre (m3). ...

of iotrolan or

iodixanol Iodixanol, sold under the brand name Visipaque, is an iodine-containing non-ionic radiocontrast agent. It is available as a generic medication. Medical uses The radiocontrast agent is given intravenously for computed tomography (CT) imaging o ...

solution Solution may refer to: * Solution (chemistry), a mixture where one substance is dissolved in another * Solution (equation), in mathematics ** Numerical solution, in numerical analysis, approximate solutions within specified error bounds * Soluti ...

. This is performed at a very slow rate of around 0.1 millilitres per minute. This prevents damage to the lymphatic vessel and disrupting the normal rate of lymph flow. It can take approximately 60 to 90 minutes for all the contrast medium to be injected. Once the contrast medium is injected, the catheter is removed, and the incisions are stitched and bandaged. A

fluoroscope Fluoroscopy () is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical imaging Medical imaging is the technique and process of imaging the interior of a ...

is used to follow the dye as it spreads through the lymphatic system through the legs, into the

groin In human anatomy, the groin (the adjective is ''inguinal'', as in inguinal canal) is the junctional area (also known as the inguinal region) between the abdomen and the thigh on either side of the pubic bone. This is also known as the medial comp ...

, and along the back of the abdominal cavity.

X-rays An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nbs ...

are taken of the legs, pelvis,

abdomen The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the to ...

, and

thorax The thorax or chest is a part of the anatomy of humans, mammals, and other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main divisions of the cre ...

areas. The next day, another set of X-rays may be taken. If a site of

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...

(

breast cancer Breast cancer is cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, milk rejection, fluid coming from the nipple, a newly inverted nipple, or a r ...

or melanoma) is being studied to evaluate spreading, a mixture of blue dye and a

radioactive Radioactive decay (also known as nuclear decay, radioactivity, radioactive disintegration, or nuclear disintegration) is the process by which an unstable atomic nucleus loses energy by radiation. A material containing unstable nuclei is consi ...

tracer is injected next to the mass. Special cameras detect the spread of tracer along lymph channels to outlying lymph nodes. A surgeon will then use the visible blue dye or radioactivity within nodes to guide

biopsy A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a dise ...

within adjacent tissues (such as the arm pit for breast cancer) to determine possible routes of cancer spread.

History

Etymology

The name comes from the

Greek Greek may refer to: Greece Anything of, from, or related to Greece, a country in Southern Europe: *Greeks, an ethnic group. *Greek language, a branch of the Indo-European language family. **Proto-Greek language, the assumed last common ancestor ...

words "Λέμφος" ("Lemphos")("lymph"), "water lymph", and "graphien" "Γραφή"("Graphy"), "to write or record".

References

Bibliography

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Full text
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External links

(

National Library of Medicine The United States National Library of Medicine (NLM), operated by the United States federal government, is the world's largest medical library. Located in Bethesda, Maryland, the NLM is an institute within the National Institutes of Health. Its ...

and the

National Institutes of Health The National Institutes of Health, commonly referred to as NIH (with each letter pronounced individually), is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the late ...

) {{Medical imaging Projectional radiography Lymphology pt:Linfangiografia