Radiologic examination of the lymphatic circulation.

Abstract

Using a technique that has changed very little from the original, a cut down is performed over a vital blue stained lymphatic usually on the dorsum of the foot or hand. With slow injection over approximately one hour, opacification of, in the lower extremity, fore-leg, thigh, pelvic, including inguinal, external, and common iliac chains and paralumbar, including paracaval and para-aortic lymphatic chains is achieved. Contrast continues through the cisterna chyli into the thoracic duct and usually into the left subclavian vein. Arm lymphograms opacity analagous extremity vessels, but fill only axillary and supraclavicular lymphatic structures. The contrast material is usually cleared from the lymphatic channels in 24 hours, entering the nodes, but normal variations are frequent, with residual contrast material sometimes persisting in channels for up to several days. Some of the earliest uses of Lymphangiography were in the evaluation of Primary Lymphedema and in lymphographic classification into patterns of Aplasia, Hypoplasia, and &dquo;Dermal Backflow alone&dquo;.2 The lymphangiogram of a 19 year old female (Figure 1) with Lymphedema Praecox demonstrates the marked hypoplasia of subdermal lymphatics in the foreleg and thigh seen in this condition. Note the abrupt transition (Figure 2) to a normal appearing lymphatic chain proximal to the inguinal ligament, which is characteristic of this type of hypoplasia. Congenital lymphedema of the Aplastic type is seen in this 7 year old male (Figure 3) with a history of an edematous limb since six months of age (no significant difference in leg length was present). Note the absence of any significant subdermal lymphatic network, with all lymph carried by both fine and more dilated dermal lymphatic channels. Films at 24 and 48 hours