LIMFANGIOGRAFI (www.eco-org.

eu) Definition Lymphangiography, or lymph node angiogram, is a test which utilizes x-ray technology, along with the injection of a contrast agent, to view lymphatic circulation and lymph nodes for diagnostic purposes. Purpose The lymphatic system is a one way circulation that channels tissue fluid back into the heart. The watery fluid called lymph seeps out of the blood into tissues, and while journeying back to the heart, it picks up germs, cancer cells, and some waste products. Lymph passes through the lymph nodes, which are major arsenals of immune defense that attack germs carried in the lymph. Cancer cells are also subject to attack in lymph nodes. Cancers of the lymph system, such as Hodgkin's disease and non-Hodgkin's lymphomas, spread throughout the body. Treatment often depends upon finding all the disease and directing radiation to each location. Planning other kinds of treatment, such as surgery or chemotherapy, may also require that the full extent of the disease be known. The lymphatic circulation may become clogged by infection, injury, or several other types of cancer that have spread through lymphatic channels. Swelling, sometimes massive, can result from blocked lymphatics. The most outstanding example of this is the tropical disease filariasis, which results in the swelling of the legs termed elephangiasis. Lymphangiography gives precise information on the extent and location of lymph vessels and lymph nodes. Oftentimes, it is performed to evaluate the extent of a lymphatic cancer. Rarely, it is a tool, which aids surgeons attempting to reconstruct the lymphatics. Precautions Lymphangiography should not be performed on patients with dye or shellfish allergies or on patients with chronic lung disease, kidney disease, heart disease, or liver disease.

Description A lymphangiogram begins by injecting a blue dye into a hand or foot. The lymph system picks up dye, which in turn will highlight the lymph vessels. This process may take a full day. When the lymphatic channel is clearly visible, the radiologist will insert an even tinier needle into that vessel and inject a contrast agent. X rays outline the journey of the contrast agent as it travels to the heart through lymph vessels and nodes. Preparation Unless a dye allergy is suspected, no special preparation is need. If an allergy is suspected, a non-ionic contrast agent can be administered instead. Key terms Contrast agent A substance that makes shadows on x rays. Filariasis A tropical disease caused by worms that live in lymph channels. Hodgkin's disease A cancer of the lymphatic system. Lymphoma A type of lyphatic cancer. Aftercare Prior to suture removal seven to 10 days after the procedure, the patient should watch for any sign of infection around the site. Risks Lipid pneumonia can occur if the contrast agent penetrates the thoracic duct. An allergic reaction to the contrast agent is possible, causing a range of symptoms that can range from innocuous to life threatening.

LYMPHANGIOGRAM / LYMPHANGIOGRAPHY (www.urmc.rochester.edu) A lymphangiogram is a type of X-ray that is used to look at the lymph nodes and lymph vessels structures that make up your child's lymphatic system.

The Immune System - Click to Enlarge The lymphatic system is responsible for producing white blood cells that fight infection. The procedure is also called lymphangiography. About the procedure The lymphatic system does not show up on a normal X-ray of the body. Because of this, a technician will inject what is known as a contrast medium, typically a blue dye, before the procedure to make parts of the lymphatic system show up better. Lymphangiograms are rarely used today. In most instances when the lymphatic system needs to be observed, doctors now often prefer to use CT scans.

Reasons for the procedure A lymphangiogram may be used for a child who has cancer. It is typically done along with a lymph node biopsy to help the child's health care provider determine if the cancer has spread to another part of the body. These are other reasons to perform a lymphangiogram:

To determine if a particular cancer therapy is effective To evaluate the cause of swelling in an arm or leg To look for disease caused by parasites To determine if the child has Hodgkin's disease or non-Hodgkin's lymphoma

Risks of the procedure The main risks of a lymphangiogram are from a potential reaction to the dye. These reactions could include:

Fever Inflammation of the lymph vessels Infection Another allergic reaction related to the dye

The dye can also cause some pain when it is injected, and it can turn the child's skin slightly blue. The child might even comment that things he or she sees look a little bluish, too. The color can also appear in urine or stool for about two days. In rare instances, the dye can stay in the lymph nodes for up to two years. There is some risk for radiation exposure from X-rays, but most experts feel that this is a relatively low risk.

Before the procedure

The child's health care provider will ask you to sign a form giving your consent for the procedure.

Make sure the child's health care provider knows about all medications, prescription and over-the-counter, that the child is taking.

Tell the health care provider if the child has had any problems with bleeding in the past. Mention any allergies that the child has. Of particular importance is allergy to the dye that will be used.

The child will not be allowed to eat or drink for several hours before the procedure. If a lymph node biopsy is also being done, additional steps must be followed beforehand as that is a surgical procedure.

During the procedure A lymphangiogram may be performed on an outpatient basis or as part of a hospital stay. The steps of the procedure may vary, depending on the child's condition and the health care provider's practices. Generally, a lymphangiogram follows this process:

The child will probably be given a sedative to relax. The child's feet will be cleaned, and then a small amount of dye will be injected in the webbing between two toes. This helps identify the lymph channels on the child's foot.

Once a lymph channel is found, a small incision will be made and a tube will be inserted into the channel. Dye will slowly flow through the tube into the lymphatic system for the next 60 to 90 minutes.

As the dye flows through the child's body, X-rays will be taken of various locations throughout the body.

Once the dye injection is complete, the tube will be removed and the incision will be closed with small stitches.

After the procedure Results of the testing are usually available in 24 to 48 hours. If the procedure is done on an outpatient basis, you should be able to take your child home after a short observation period. The child may need to return at a later time to have the stitches removed. You will need to watch the child closely for awhile to make sure he or she has no adverse effects from the injection of the dye. Contact the child's health care provider immediately if you notice any type of reaction. The health care provider will give you specific instructions regarding movement and care of the child's foot, pain medication, symptoms to watch for, and any activity restrictions. It's likely that you will need to make sure the child rests his or her foot for at least several hours after the procedure. As far as food is concerned, you should be able to give the child whatever he or she likes best as soon as you get home. Diet restrictions are not common after this procedure.

LYMPHANGIOGRAM/LYMPHANGIOGRAPHY (www.nlm.nih.gov)

A lymphangiogram is used to evaluate the possible spread of cancers and the effectiveness of cancer therapy. The X-rays may also help determine the cause of swelling in an arm or leg and check for parasitic diseases. The test is performed by injecting blue dye into an area to be tested. The blue dye helps to locate the lymphatic vessels where the catheter will be placed. Once the lymph vessels are found, contrast medium is injected through the catheter and X-rays are taken to monitor its progress as it spreads through the lymph system up the legs, into the groin, and along the back of the abdominal cavity. The next day, another set of X-rays is taken.

LYMPHANGIOGRAM (LYMPHANGIOGRAPHY) X-ray scan of the lymph glands using dye injected into the bloodstream. This test is rarely used now, as CT and MRI scans can check the lymph glands.

LYMPHANGIOGRAM (www.nlm.nih.gov) A lymphangiogram is a special x-ray of the lymph nodes and lymph vessels. Lymph nodes produce white blood cells (lymphocytes) that help fight infections. The lymph nodes also filter and trap cancer cells. The lymph nodes and vessels are not seen on a normal x-ray, so a dye or radioisotope (radioactive compound) is injected into the body to highlight the area being studied. How the Test is Performed You may be offered a sedative before the test to help you relax. You sit in a special chair or on an x-ray table. The health care provider cleans your feet, and then injects a small amount of blue dye into the area (called webbing) between your toes. Thin, bluish lines appear on the top of the foot within 15 minutes. These lines identify the lymph channels. The health care provider numbs the area, makes a small surgical cut near one of the larger blue lines, and inserts a thin flexible tube into a lymph channel. This is done on each foot. Dye (contrast medium) flows through the tube very slowly, over a period of 60 to 90 minutes. A special x-ray machine, called a fluoroscope, projects the images on a TV monitor. The health care provider uses the images to follow the dye as it spreads through the lymphatic system up your legs, groin, and along the back of the abdominal cavity. Once the dye is completely injected, the catheter is removed and stitches are used to close the surgical cut. The area is bandaged. X-rays are taken of the legs, pelvis, abdomen, and chest areas. More x-rays may be taken the next day.

If the test is being done to see if breast cancer or melanoma has spread, the blue dye is mixed with a radioactive compound. Special cameras watch how the substance spreads to other lymph nodes. This can help your doctor better understand where the cancer has spread when a biopsy is being performed. How to Prepare for the Test You must sign a consent form. You may be asked to not eat or drink for several hours before the test. You may wish to empty your bladder just before the test. Tell the health care provider if you are pregnant or you have bleeding problems. Also mention if you've had allergic reactions to x-ray contrast material or any iodine-containing substance. If you are having this test done with sentinel lymph node biopsy (for breast cancer and melanoma), you will need to prepare for the operating room. A surgeon and anesthesiologist will tell you how to prepare for the procedure. How the Test Will Feel Some patients feel a brief sting when the blue dye and numbing medicines are injected. You may feel pressure as the dye starts to flow into your body, particularly behind the knees and in the groin area. The surgical cuts will be sore for a few days. The blue dye causes skin, urine, and stool discoloration for about 2 days. Why the Test is Performed A lymphangiogram is used with lymph node biopsy to determine the possible spread of cancer and the effectiveness of cancer therapy. Contrast dye and x-rays are used to help determine the cause of swelling in an arm or leg and check for diseases that may be caused by parasites. Additional conditions under which the test may be performed:

Hodgkin's lymphoma Non-Hodgkin's lymphoma

What Abnormal Results Mean Enlarged lymph nodes (swollen glands) that have a foamy appearance may be a sign of lymphatic cancer. Nodes or parts of the nodes that do not fill with the dye suggest a blockage and may be a sign of cancer spreading through the lymph system. Blockage of the lymph vessels may be caused by tumor, infection, injury, or previous surgery. Talk to your doctor about the meaning of your specific test results. Risks Risks related to the injection of the dye (contrast medium) may include:

Allergic reaction Fever Infection Inflammation of the lymph vessels

There is low radiation exposure. However, most experts feel that the risk of most x-rays is smaller than other risks we take every day. Pregnant women and children are more sensitive to the risks of the x-ray. Considerations The dye (contrast medium) can stay in the lymph nodes for up to 2 years.

What Is Lymphangiography? (www.wisegeek.com) Lymphangiography is a type of medical imaging study which is used to visualize the lymphatic system, the network of vessels and nodes which moves lymph throughout the body. This procedure is done in a hospital or clinical setting and is supervised by a radiologist or medical technician. The purpose of the lymphangiography is to gather information which can be used diagnostically to learn more about why a patient is experiencing specific symptoms and to potentially rule out certain medical issues. Patients are often sedated for this procedure because it can be time consuming and uncomfortable. The patient will be awake, but relaxed as a result of the sedative, which will make the lymphangiography more pleasant. The lymphangiography starts with injecting a dye into the feet or hands. This dye will flow into the lymphatic system and become visible, allowing a doctor, nurse, or technician to insert a catheter into one of the vessels which carries lymph. The catheter is used to introduce a contrast dye, also known as a contrast agent. Contrast dyes are radiopaque, which means that they will show up on X-ray images. The movement of the contrast dye is followed with the assistance of a fluoroscope, which generates a moving X-ray image of the body. Once it has disseminated throughout the lymphatic system or area of interest, sets of Xrays can be taken. More X-rays may be taken on the following day. After the procedure, the patient may feel slightly sore, especially behind the knees. Commonly body fluids like urine are also stained with the dye used at the start of the procedure to locate the lymph vessels, and this will resolve in several days once the body has expressed all of the dye. The results of the lymphangiography may be read immediately or interpreted at a different time and discussed with the patient later. One reason for a doctor to order a lymphangiography is concerns about blockages in the lymphatic system. If a patient has a swollen leg or arm which is believed to be the result of a backup of lymph, for example, a lymphangiography can be used to find the blockage so that it

can be addressed. This type of medical imaging can also be used to check for signs of cancer, although it is possible to get a false negative on a lymphangiography, so a clear result does not necessarily mean that the patient does not have cancer.