Intranodal Lymphangiogram: Technical Aspects and Findings

Abstract

INL succeeded in all patients. Lipiodol leaked into the vein through a lymphaticovenous anastomosis at the femoral or pelvic region in all patients.

Ultrasound-guided intranodal lipiodol lymphangiography from the groin is useful for assessment and treatment of post-esophagectomy chylothorax in three cases

“…Lipiodol (Terumo, Tokyo, Japan) injection was performed manually at a rate of 0.1 mL/min. During the injection, fluoroscopy was used intermittently to confirm that the injected lipiodol was entering the lymphatic vessels [9].…”

Percutaneous Treatment of Chylous Ascites

“…Some authors have suggested that the junction of the hilum and cortex should be targeted to achieve success. 28,29 Although this is also true in our experience, lymphangiography was nevertheless successful in any location regardless of whether the cortex or hilum was punctured. However, because of abundant fat within the hilum, a higher rate of extravasation was demonstrated when the needle tip was positioned at the center of the lymph node.…”

“…Lipiodol injection was performed manually using a 3-mL syringe and controlled injection was performed allowing 3 mL of Lipiodol to be injected over a time of 6 minutes (0.5 mL/min). This rate is a little faster than that described in an earlier study by Kariya et al 28 where the injection rate was either 1 mL/3 min. The rate ranges between 0.2 and 0.4 mL/min in other reports.…”

“…12 Furthermore, the presence of lymphaticovenous anastomoses may allow significant amount of Lipiodol to be shunted into the systemic venous system to result in pulmonary embolism. 28 The reported complication of lower extremity edema for pedal lymphangiography is no longer an issue which the current trend in intranodal technique. With respect to percutaneous embolization using a fine needle, there are no reported complications related to transperitoneal puncture.…”

“…If a lymphaticovenous shunt is seen, caution must be taken not to allow excessive shunting of Lipiodol into the systemic venous circulation that may consequently result in pulmonary oil embolism. 28 The maximum dose of Lipiodol should not exceed 20 mL owing to risk of pulmonary embolism. 11 Fluoroscopy is used intermittently to avoid excessive radiation to the patient and operator.…”