Hepatography and liver lymphography by retrograde biliary ethiodol infusion: an experimental study in the dog

Ethiodol in dosages of 0.5-3 ml/kg was retrogradely infused with hydrostatic pressure of 50--100 cm water into the biliary system of nine cholecystectomized dogs equipped with a Thomas cannula in the second portion of the duodenum, allowing cannulation of the common bile duct with a Foley catheter under direct vision. A total of 18 examinations were performed. A dense hepatogram and complete visualization of the hepatic lymph nodes were obtained when the infused Ethiodol dosage exceeded the capacity of the biliary system by 10 ml or more. The hepatogram lasted for three to four months and the lymph nodes were opacified for a year and longer. Contrary to angiographic contrast agents, Ethiodol retrogradely infused into the biliary system primarily refluxes from the biliary system to the lymph and not to the blood. Judged by serial chest radiographs and lung scans, pulmonary Ethiodol emboli did not occur. A significant temporary increase in serum bilirubin and liver enzymes followed the procedure but these returned to normal within a week to a month. Periodic needle biopsies of the liver showed Ethiodol droplets initially in the interstitium and lymphatics, and subsequently in hepatocytes, Kupffer's cells and the epithelium of small bile ductules. No hepatic damage was found histologically on long-time follow-up examinations.