Lymphangiography

Lymphangiography is prescribed to study the lymphatic system. The study is based on fluoroscopy using a contrast agent that is injected into the patient’s soft tissues or directly into the lymphatic system. Examination helps to detect cancer in the early stages. In the treatment and diagnosis of progressive edema of the extremities, lymphangiography is considered a significant and informative method of visual diagnostics. It has its own characteristics in the preparation of the patient, his rehabilitation, contraindications.

Indications for research

The lymphatic system is part of the human circulatory and cardiovascular systems. It consists of lymphatic capillaries, vessels, ducts, nodes. Like the venous system, the lymphatic system is involved in the transport of fluids throughout the body. Also, the lymphatic system is an important part of the immune system, providing protection from damaged cells, tumor cells and foreign particles (for example, bacteria and viruses) that could penetrate into the tissue fluids. In the lymph nodes, they are filtered out of the lymph and destroyed by lymphocytes, dendritic cells and macrophages. Thus, important functions of the lymphatic system are to remove damaged cells from the body and provide protection against the spread of infection and malignant tumors.

To examine the state of the lymphatic system, lymphangiography is prescribed. It is also called lymphography or X-ray lymphoscopy. The method is based on contrast radiography, as one of the subtypes of angiography. The contrast is a substance that is injected inside and stains the lymphatic vessels. As a result, all the necessary areas of the lymphatic system, neoplasms, and changes in the structure are clearly visible on the images.

When examining individual parts of the body, contrast is injected into the intended affected area – the “zone of interest”. For example, the introduction of a contrast agent into the lymphatic vessels of the foot allows visualization of the lymphatic pathways of the legs, inguinal and iliac regions, as well as the retroperitoneal space (up to the thoracic duct). The introduction of a contrast agent into the lymphatic vessels of the hands provides visualization of the axillary and supraclavicular lymph nodes.

Depending on the examined area of ​​the body, there are such types of lymphography:

• cervical;
• upper limbs;
• lower limbs.

For the zone of the cervical lymph nodes, this method is uninformative, therefore it is rarely used for this purpose. For the diagnosis of axillary and supraclavicular lymph nodes, a contrast agent is injected into the hand. When it is introduced into the foot, it is possible to examine in detail the condition in the inguinal, retroperitoneal, iliac region. As a contrast, various agents and methods of administration are used, based on this, these types of lymphangiography are distinguished:

1. Direct – means the introduction of iodinated contrast agent into the lymphatic vessels.
2. Indirect – involves the introduction of a substance intramuscularly, from where it gradually enters the lymphatic system.
3. Radionuclide – a substance is introduced that contains a small amount of radionuclides. The administered dose is absolutely safe for humans, but allows you to get much more informative results.
4. Fluorescent – still not very common, based on the introduction of a fluorescent substance, which is characterized by a specific glow. It also has a high accuracy of results.

The patient may ask what kind of diagnosis is indicated for him, he may refuse it in favor of another type of study.

When is a lymphogram needed?

The referral to the procedure is written out by the oncologist, performed and deciphered by the radiologist. You should not “prescribe” yourself an examination, since it is based on exposure and there must be strong indications for this. The doctor may prescribe a study for the diagnosis of lymphoma, differential diagnosis between primary and secondary lymphedema, when determining indications for surgical treatment for malignant neoplasms, as well as to evaluate the effectiveness of chemotherapy and radiation therapy.

Examination of the lymphatic system is also effective in the following situations:

• to establish the cause of the inflammatory process in the examined area;
• with increasing and not passing swelling of the extremities – “elephantiasis”;
• if blood circulation in the lower and upper extremities is disturbed;
• with suspicion of metastases.

In women, such diagnostics can detect breast cancer and ovarian cysts, so gynecologists and mammologists are increasingly using lymphography data. Pictures of the lymphatic system allow you to establish a diagnosis, the need for surgical intervention, the effectiveness of treatment.

Contraindications to the study

Like other radiation-based examination methods, lymphangiography has contraindications. Children under 14 years of age are trying to find alternative methods of diagnosis, but in extreme cases they use this one. Pregnant women undergo this procedure only with the permission of their obstetrician-gynecologist and other doctors who observe it. Nursing mothers can be diagnosed by fluoroscopy, but after that it is imperative to stop feeding for 2 days. A break in feeding is necessary due to the fact that the contrast agent is excreted from the body with fluid, in women with breast milk.

Before the study, it is imperative to establish whether the patient is allergic to contrast components. Particular attention is paid to allergies to iodine. Other contraindications include severe diseases of the liver, kidneys, respiratory organs and heart. If the patient has the listed indications, a study of the lymphatic system can be ordered only if the benefits of the study outweigh the potential risks.

Where can you get this test

Such a study can be provided by a public hospital if it is properly equipped. This requires equipment for fluoroscopy with a gamma camera, computer equipment, a contrast agent and an experienced specialist. In most cases, such equipment is available in private clinics. Also, the study can be done in diagnostic centers or oncology clinics. Immediately after the end of the study, the radiologist will decipher the data and issue it in the form of documents.

The price for such a service depends on the policy of the medical institution in which the examination takes place. The cost in a public clinic can only be found on the spot, since such institutions rarely use advertising. Private centers offer one session, which will cost 200-450 dollars. This price range is determined by the brand of the CT scanner, the type of contrast agent, the level and reputation of the clinic. You can also find offers from foreign clinics, for example in Israel, but this procedure does not require flights abroad, since in a private medical center in Russia, Belarus, Ukraine you can get the same result, but for less money.

Preparation for research

If the diagnosis of the lymphatic system is prescribed, the patient is subjected to allergy tests for the constituent components of the contrast. In the absence of contraindications, you can go to an appointment with a radiologist. It is advisable to stop drinking 4-6 hours before the appointment, since the procedure is carried out only with an empty bladder. Jewelery and removable dentures must be removed before x-rays.

Research progress

Regardless of the type of lymphography, the procedure is performed according to a similar scheme: first, contrast is introduced, and then radiography. Among doctors, the direct technique with the introduction of the drug into the lymphatic vessel is more popular; this is a safe and low-traumatic method with detailed information.

Stages of the study:

1. The patient changes into a hospital gown. Be sure to remove jewelry and removable dentures, warns the doctor about the presence of metal plates in the body, implants.
2. The patient is placed on a special couch, he is subcutaneously injected with a dye – Evans blue. Depending on the “zone of interest”, it is injected between the toes or in the hand. After 10-15 minutes, a blue network of vessels appears on the surface of the skin.
3. The doctor selects the largest area, then injects an anesthetic at the location of large vessels.
4. After anesthesia, a small incision is made to expose the vessel and a catheter is inserted through which a radiopaque substance will flow for one and a half hours.
5. Stitches and a bandage are applied at the incision site.
6. At the final stage, a series of images of the lower extremities, abdominal and inguinal region, hands or other examined parts of the body are taken.

A day after this, another series of photos is needed, but without the introduction of additional drugs. The contrast remains in the lymphatic system for up to 2 years, without interfering with the patient, this makes it possible to monitor the course of the disease and the effectiveness of treatment without the constant injection of contrast.

Rehabilitation and possible complications

Special rehabilitation measures for the patient are not provided, since the process is less traumatic. You can eat, drink and walk immediately after taking the pictures. Exceptions can only be determined by a doctor, for example, with low blood clotting. Possible complications include: edema at the site of catheter insertion, local redness, hematoma formation. More severe consequences include injury to the vessel with improper administration, an allergic reaction to the substance, and infection of the sutures. But such side effects can be avoided if you strictly follow the doctor’s recommendations, pass an allergy test. Unfortunately, it is quite difficult to guess the competence of a doctor. Before making an appointment, if possible, it is better to look for reviews about the clinic and the radiologist. But negative consequences are extremely rare. In most cases, this process is favorable and quite comfortable for the patient, gives accurate results and eliminates the risk of misdiagnosis.