Intranodal Lymphangiography: Feasibility and Preliminary Experience in Children

Rajebi, Mohammad Reza; Chaudry, Gulraiz; Padua, Horacio M.; Dillon, Brian; Yilmaz, Sabri; Arnold, Ryan W.; Landrigan-Ossar, Mary F.; Alomari, Ahmad I.

doi:10.1016/j.jvir.2011.05.003

« Previous Next »Journal of Vascular and Interventional Radiology
Volume 22, Issue 9 , Pages 1300-1305, September 2011

Intranodal Lymphangiography: Feasibility and Preliminary Experience in Children

Mohammad Reza Rajebi, MD
- Division of Vascular and Interventional Radiology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave., Boston, MA 02215
Gulraiz Chaudry, MB, ChB
- Division of Vascular and Interventional Radiology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave., Boston, MA 02215
Horacio M. Padua, MD
- Division of Vascular and Interventional Radiology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave., Boston, MA 02215
Brian Dillon, MD
- Division of Vascular and Interventional Radiology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave., Boston, MA 02215
Sabri Yilmaz, MD
- Division of Vascular and Interventional Radiology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave., Boston, MA 02215
Ryan W. Arnold, MD
- Division of Vascular and Interventional Radiology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave., Boston, MA 02215
Mary F. Landrigan-Ossar, MD, PhD
- Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave., Boston, MA 02215
Ahmad I. Alomari, MD, MSc
- Division of Vascular and Interventional Radiology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave., Boston, MA 02215
- Address correspondence to A.I.A.

Received 9 April 2011; received in revised form 6 May 2011; accepted 10 May 2011. published online 29 June 2011.

Abstract

Purpose

To review an initial experience studying the lymphatic system using direct injection of ethiodized oil contrast medium into lymph nodes (ie, intranodal lymphangiography) in children with chylous disorders.

Materials and Methods

Children with chylous disorders who underwent intranodal lymphangiography were included in this retrospective study. Under general anesthesia, ultrasonography was used to guide the placement of a small-bore (22–25-gauge) needle into an inguinal lymph node. Ethiodized oil contrast medium was very slowly injected into the node. Opacification of the lymphatic system was documented with fluoroscopic and digital substraction imaging and videofluoroscopic clips.

Results

Five children (age range, 6 wk to 17 y) with chylous vaginorrhea (n = 1), postoperative chylothorax (n = 2), or spontaneous chylothorax (n = 2) underwent intranodal lymphangiography. The amount of ethiodized oil injected was 0.5–4.5 mL. Intranodal lymphangiography was successfully completed in four patients. One procedure was terminated because of patient motion and extravasation of contrast medium. Lymphangiographic findings included a spectrum of lymphatic channel disorders including incompetence, obstruction, collateralization, chylous reflux, and chylous leak. There were no complications.

Conclusions

The simplified technique of injecting contrast medium into a lymph node to opacify the lymphatic system in children can be an alternative to the more elaborate conventional lymphangiography.