Intranodal Lymphangiography: Feasibility and Preliminary Experience in Children

• Published in: Journal of vascular and interventional radiology Vol. 22; no. 9; pp. 1300 - 1305
• Main Authors: Rajebi, Mohammad Reza, MD, Chaudry, Gulraiz, MB, ChB, Padua, Horacio M., MD, Dillon, Brian, MD, Yilmaz, Sabri, MD, Arnold, Ryan W., MD, Landrigan-Ossar, Mary F., MD, PhD, Alomari, Ahmad I., MD, MSc
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2011
• Subjects: Adolescent; Anesthesia, General; Boston; Child; Child, Preschool; Chylothorax - diagnostic imaging; Contrast Media; Ethiodized Oil; Feasibility Studies; Female; Fluoroscopy; Humans; Infant; Lymph Nodes - diagnostic imaging; Lymphatic Diseases - diagnostic imaging; Lymphography - methods; Male; Pilot Projects; Predictive Value of Tests; Radiographic Image Enhancement; Radiography, Interventional; Radiology; Retrospective Studies
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2011.05.003

Abstract Purpose To review an initial experience studying the lymphatic system using direct injection of ethiodized oil contrast medium into lymph nodes (ie, intranodal lymphangiography) in children with chylous disorders. Materials and Methods Children with chylous disorders who underwent intranodal lymphangiography were included in this retrospective study. Under general anesthesia, ultrasonography was used to guide the placement of a small-bore (22–25-gauge) needle into an inguinal lymph node. Ethiodized oil contrast medium was very slowly injected into the node. Opacification of the lymphatic system was documented with fluoroscopic and digital substraction imaging and videofluoroscopic clips. Results Five children (age range, 6 wk to 17 y) with chylous vaginorrhea (n = 1), postoperative chylothorax (n = 2), or spontaneous chylothorax (n = 2) underwent intranodal lymphangiography. The amount of ethiodized oil injected was 0.5–4.5 mL. Intranodal lymphangiography was successfully completed in four patients. One procedure was terminated because of patient motion and extravasation of contrast medium. Lymphangiographic findings included a spectrum of lymphatic channel disorders including incompetence, obstruction, collateralization, chylous reflux, and chylous leak. There were no complications. Conclusions The simplified technique of injecting contrast medium into a lymph node to opacify the lymphatic system in children can be an alternative to the more elaborate conventional lymphangiography.