View source for Lymphogram

{{Short description|Deprecated medical imaging technique to visualise the lymphatic system}}
{{Infobox interventions |
  Name        = Lymphogram |
  Image       = |
  Caption     = |
  ICD10       = |
  ICD9        = {{ICD9proc|87.08}} |
  MeshID      = |
  OPS301      = {{OPS301|3-62}} |
  OtherCodes  = |
|specialty=[[Radiology]]}}
'''Lymphography''' is a [[medical imaging]] technique in which a [[radiocontrast]] agent is injected, and then an [[X-ray]] picture is taken to visualise structures of the [[lymphatic system]], including [[lymph node]]s, [[Thoracic duct|lymph ducts]], [[lymphatic tissues]], [[lymph capillaries]] and [[lymph vessel]]s. '''Lymphangiography''' is the same procedure, used only to visualize the [[lymph vessel]]s.<ref name=":0">{{Citation|title=Lymphography|date=2018-01-01|url=https://www.sciencedirect.com/science/article/pii/B9780323524810500422|work=Diagnostic Imaging: Interventional Procedures (Second Edition)|pages=294–297|editor-last=Wible|editor-first=Brandt C.|series=Diagnostic Imaging|publisher=Elsevier|language=en|doi=10.1016/b978-0-323-52481-0.50042-2|isbn=978-0-323-52481-0|access-date=2021-03-03|url-access=subscription}}</ref> The x-ray film or image of the [[Lymphatic vessel|lymphatic vessels]] and [[Lymph node|lymph nodes]] is called a '''lymphogram''' or a '''lymphangiogram'''.

Radiographs can be taken after injection of a [[radiodensity|radiopaque]] contrast medium into small lymphatic vessels (these are made visible by prior [[subcutaneous injection]] of patent blue dye). The resulting lymphogram is used to find the locations of large vessels and nodes, and to identify sites of blockage in lymphatic drainage.

Lymph nodes can also be detected via [[Nuclear medicine|radionuclide imaging]] after injection of radioactive [[colloid]]s. [[Macrophage]]s [[Phagocytosis|phagocytose]] these foreign bodies and sequester in the nodes.

== Use ==
Lymphography is used to visualise the structures of the [[lymphatic system]], including [[lymph node]]s, [[Thoracic duct|lymph ducts]], [[lymphatic tissues]], [[lymph capillaries]] and [[lymph vessel]]s. It can be used during thoracic duct embolisation.<ref>{{Citation|title=Thoracic Duct Embolization|date=2018-01-01|url=https://www.sciencedirect.com/science/article/pii/B9780323524810500434|work=Diagnostic Imaging: Interventional Procedures (Second Edition)|pages=298–301|editor-last=Wible|editor-first=Brandt C.|series=Diagnostic Imaging|publisher=Elsevier|language=en|doi=10.1016/b978-0-323-52481-0.50043-4|isbn=978-0-323-52481-0|s2cid=244782861 |access-date=2021-03-04|url-access=subscription}}</ref>

Lymphography is not commonly used in modern medicine since the adoption of [[CT scan]] and [[Positron emission tomography|PET scan]] technologies.<ref name=":0" />

== Risks ==
Lymphograhy is usually considered a very safe procedure.<ref name=":1">{{Citation|title=Iodinated contrast media|date=2016-01-01|url=https://www.sciencedirect.com/science/article/pii/B9780444537171009100|work=Meyler's Side Effects of Drugs (Sixteenth Edition)|pages=239–297|editor-last=Aronson|editor-first=J. K.|place=Oxford|publisher=Elsevier|language=en|doi=10.1016/b978-0-444-53717-1.00910-0|isbn=978-0-444-53716-4|access-date=2021-03-04|url-access=subscription}}</ref> The most serious adverse reaction tends to be a possible [[Allergy|allergic reaction]] to injected [[contrast agent]].<ref name=":1" />

Lymphography is often an invasive procedure.<ref name=":0" /> It may be difficult to access [[Lymphatic vessel|lymphatic vessels]], as they are usually very narrow and hard to locate. The procedure also takes a very long time to perform.<ref name=":0" />

== Technique ==
A needle or [[catheter]] is inserted into a [[lymphatic vessel]] in either the [[foot]] or the [[arm]]. A [[contrast agent]] is injected into the lymphatic vessel.<ref name=":0" /> This may be around 2 to 4 [[Millilitre|millilitres]] of [[iotrolan]] or [[iodixanol]] [[Solution (chemistry)|solution]].<ref name=":1" /> This is performed at a very slow rate of around 0.1 millilitres per [[minute]].<ref name=":1" /> This prevents damage to the lymphatic vessel and disrupting the normal rate of lymph flow. It can take approximately 60 to 90 [[minute]]s for all the contrast medium to be injected. Once the contrast medium is injected, the catheter is removed, and the incisions are [[Surgical suture|stitched]] and [[Bandage|bandaged]].

A [[Fluoroscopy|fluoroscope]] is used to follow the dye as it spreads through the lymphatic system through the [[Leg|legs]], into the [[groin]], and along the back of the [[abdominal cavity]]. [[X-ray|X-rays]] are taken of the legs, [[pelvis]], [[abdomen]], and [[thorax]] areas. The next day, another set of X-rays may be taken.

If a site of [[cancer]] ([[breast cancer]] or [[melanoma]]) is being studied to evaluate spreading, a mixture of blue dye and a [[radioactive]] tracer is injected next to the mass.<ref name=":1" /> Special cameras detect the spread of tracer along lymph channels to outlying lymph nodes. A [[surgeon]] will then use the visible blue dye or radioactivity within nodes to guide [[biopsy]] within adjacent tissues (such as the arm pit for breast cancer) to determine possible routes of cancer spread.<ref name=":1" />

== History ==

=== Etymology ===
The name comes from the [[Greek language|Greek]] words "Λέμφος" ("Lemphos")("lymph"), "water lymph", and "graphien" "Γραφή"("Graphy"), "to write or record".

==References==
<references />

=== Bibliography ===
* {{cite journal |vauthors=Guermazi A, Brice P, Hennequin C, Sarfati E |title=Lymphography: an old technique retains its usefulness |journal=Radiographics |volume=23 |issue=6 |pages=1541–58; discussion 1559–60 |year=2003 |pmid=14615563 |doi=10.1148/rg.236035704}} ''[http://radiographics.rsnajnls.org/cgi/content/full/23/6/1541 Full text]''

== External links ==
* [https://www.nlm.nih.gov/medlineplus/ency/article/003798.htm About lymphangiogram] ([[National Library of Medicine]] and the [[National Institutes of Health]])

{{Operations and other procedures of the hemic and lymphatic system}}
{{Medical imaging}}

[[Category:Diagnostic radiology]]
[[Category:Lymphology]]
[[Category:Projectional radiography]]

[[pt:Linfangiografia]]