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Intranodal lymphangiogram: technical aspects and findings
Shuji Kariya1, Atsushi Komemushi, Miyuki Nakatani
1Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan, kariyas@hirakata.kmu.ac.jp.
Purpose:
To report the technical results and imaging findings of intranodal lymphangiogram (INL).
Materials And Methods:
we studied four patients (three men, one woman) who had persistent chylous leakage despite conservative treatment after esophageal cancer surgery. Their mean age was 68 years (range 61-74 years). The inguinal or femoral lymph node was punctured under ultrasound guidance using a 60-mm-long, 23-gauge needle. If the lipiodol injected via the needle showed granular nodules on fluoroscopy, lipiodol injection was continued manually at a rate of 1 mL/3 min for INL. If the cisterna chyli was detectable on the lymphangiogram, it was punctured percutaneously via the abdomen by a needle under fluoroscopy, and thoracic duct embolization was performed.
Results:
INL was successful in all patients. Lymphaticovenous anastomoses at the femoral or pelvic region were confirmed in all four patients. In one case, a different ipsilateral lymph node was punctured because major flow of lipiodol into the veins through a lymphaticovenous anastomosis occurred. Catheter cannulation and embolization were successful for three of the four patients. In unsuccessful procedures, the cisterna chyli was not visualized, and puncture was not possible.
Conclusions:
INL succeeded in all patients. Lipiodol leaked into the vein through a lymphaticovenous anastomosis at the femoral or pelvic region in all patients.
