Cardiovascular and interventional radiology

Intranodal lymphangiogram: technical aspects and findings.

PMID 24722896


To report the technical results and imaging findings of intranodal lymphangiogram (INL). 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. 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. INL succeeded in all patients. Lipiodol leaked into the vein through a lymphaticovenous anastomosis at the femoral or pelvic region in all patients.