lympografi lain

8/17/2019 Lympografi Lain

1/39

LymphographyLymphographyByBy

Dr/ Dina MetwalyDr/ Dina Metwaly


2/39

lymphatic systemlymphatic system

it is part of the circulatory system, comprising ait is part of the circulatory system, comprising a

network of lymphatic vessels that carry a clearnetwork of lymphatic vessels that carry a clear

uid called lymph directionally towards theuid called lymph directionally towards theheart.heart.

he lymphatic system consists of lymphatic he lymphatic system consists of lymphatic

organs, a conducting network of lymphaticorgans, a conducting network of lymphatic

vessels, and the circulatingvessels, and the circulating lymph..


3/39

The Lymphatic System functionsThe Lymphatic System functions

Slide 12.1Slide 12.1

• Transport clean fluids back to the

blood

•

Drains excess fluids from tissues

• Removes “debris” from cells of

body

• Transports fats from digestive

system


4/39

Lymphatic !ystemLymphatic !ystem

hymus hymus

"land"land

LymphLymph

#essels#essels

Lymph $odesLymph $odes

!pleen!pleen

onsils onsils


5/39


6/39

Lymphatic CapillariesLymphatic Capillaries

• luid leaks through mini!valves into lymph capillaries

• "igher pressure on the inside closes mini!valves


7/39

Lymphatic #esselsLymphatic #essels

• Collects lymph from lymph

capillaries

•

Delivers lymph to lymph nodes

• Returns fluid to circulatory

veins near the heart

• Right lymphatic duct

• Thoracic duct


8/39

Lymphatic System StructuresLymphatic System Structures


9/39


• %ilter lymph &efore it is returned

to the &lood

•

Defense cells in nodes'

• Medulla houses macrophages

which engulf and destroy

foreign su&stances

• (orte) nurtures lymphocytes

which provide immune

response to antigens *corte)+


10/39

Lymphoid %rgansLymphoid %rgans

• Several other organs

contribute to lymphatic

function

&' Spleen

(' Thymus

)' Tonsils

*' +eyer,s patches

igure &('-


11/39

The SpleenThe Spleen

• ilters blood

• Destroys .orn out blood cells

• orms blood cells in the fetus

• /cts as a blood reservoir


12/39

The ThymusThe Thymus

• unctions at peak levels only

during childhood

• +roduces hormones 0like

thymosin1 to program

lymphocytes


13/39

TonsilsTonsils

• Small masses of lymphoid

tissue around the pharynx

•

Trap and remove bacteria and

other foreign materials

• Tonsillitis is caused by

congestion .ith bacteria


14/39

+eyer,s +atches+eyer,s +atches “Tonsils of the intestine”“Tonsils of the intestine”

• ound in the .all of the small intestine

• Capture and destroy bacteria in the

intestine


15/39

LymphographyLymphography

"eneral term applied to the"eneral term applied to the

radiologic e)amination of'radiologic e)amination of'

Lymph nodesLymph nodes

*lymphadenography+ '*lymphadenography+ '

radiographic visualiation of theradiographic visualiation of the

lymph nodes .lymph nodes .

Lymph #essels' endovascularLymph #essels' endovascular

in-ection of radiopaue materialin-ection of radiopaue material

into a lymphatic vesselinto a lymphatic vessel


16/39

sually done to demonstrate pelvis andsually done to demonstrate pelvis and

a&domena&domen

0n-ected in foot0n-ected in foot

%or a)illary, clavicular area and upper lim&s%or a)illary, clavicular area and upper lim&s

0n-ected in hand (hecks drainage of lymph0n-ected in hand (hecks drainage of lymph

nodesnodes


17/39

0ndications0ndications

1dema in lim&s &y1dema in lim&s &y

#isualiation of vessel#isualiation of vessel

o&structiono&struction

0nfections0nfections

2ule out cancer2ule out cancer

Lymphoma staging 3 (heckLymphoma staging 3 (heckfor metastasisfor metastasis

!ie, shape, location of!ie, shape, location of

enlarged nodesenlarged nodes


18/39

(ontraindications(ontraindications

4regnancy4regnancy

4eople with allergies to iodine5&ased4eople with allergies to iodine5&ased

contrast dyes.contrast dyes. people with severe chronic lung, heart,people with severe chronic lung, heart,

kidney, or liver disease.kidney, or liver disease.


19/39

4re 4rocedure4re 4rocedure

6&tain 4 history6&tain 4 history

6&tain 4 consent6&tain 4 consent

Make sure to have all suppliesMake sure to have all supplies

Make sure the a&sence of contraindications,Make sure the a&sence of contraindications,

which are cardiovascular or pulmonarywhich are cardiovascular or pulmonary

diseasedisease

4ositioning aides and comfort supplies4ositioning aides and comfort supplies


20/39

(ontrast(ontrast

7ater &ased *less commonly used as it di8use in7ater &ased *less commonly used as it di8use in

near&y tissues+.near&y tissues+.

6il &ased6il &ased

More commonly usedMore commonly used

1thiodal1thiodal

LipodalLipodal

Dose' he total amount of oily contrast mediumDose' he total amount of oily contrast medium

in-ected on each side should never e)ceed 9: mLin-ected on each side should never e)ceed 9: mL

4rocedure of lower lim&4rocedure of lower lim&


21/39

4rocedure of lower lim&4rocedure of lower lim&

lymphography * pedallymphography * pedal

lymphangiography+lymphangiography+

0n-ection of mi)ture of local anesthesia ; methylene0n-ection of mi)ture of local anesthesia ; methylene

&lue violet on the dorsal aspect of the foot &etween the&lue violet on the dorsal aspect of the foot &etween the

toes.toes.

longitudinal incision 555< isolation of lymphatic vessellongitudinal incision 555< isolation of lymphatic vessel

from the surrounding fatty tissuefrom the surrounding fatty tissue


22/39

visualiation of super=cial collectors aftervisualiation of super=cial collectors aftersu&cutaneous in-ection of contrast materialsu&cutaneous in-ection of contrast material

9.9. into the =rst and second inter5metatarsal spacesinto the =rst and second inter5metatarsal spaces

of the dorsal foot *for super=cial circulation+of the dorsal foot *for super=cial circulation+oror

>.>. or lateral retro5malleolar space *for deepor lateral retro5malleolar space *for deep

circulation+circulation+ $odes in pelvis and a&domen are demonstrated$odes in pelvis and a&domen are demonstrated

with foot in-ectionwith foot in-ection


23/39

? needle or catheter is inserted into a lymphatic? needle or catheter is inserted into a lymphatic

channel in either the foot or arm, and a contrastchannel in either the foot or arm, and a contrast

medium is in-ected into the &ody at a very slow ratemedium is in-ected into the &ody at a very slow rate

*appro)imately @: to A: minutes for all the contrast*appro)imately @: to A: minutes for all the contrast

medium to &e in-ected+.medium to &e in-ected+.

? uoroscope is used to follow the dye as it spreads? uoroscope is used to follow the dye as it spreads

through the lymphatic system through the legs, into thethrough the lymphatic system through the legs, into the

groin, and along the &ack of the a&dominal cavity.groin, and along the &ack of the a&dominal cavity.

6nce the contrast medium is in-ected, the catheter is6nce the contrast medium is in-ected, the catheter is

removed, and the incisions are stitched and &andaged.removed, and the incisions are stitched and &andaged.


24/39

%ilming%ilming

5rays are usually taken 9 C2 after pressure5rays are usually taken 9 C2 after pressure

in-ection that takes a&out E minutesin-ection that takes a&out E minutes

?fter 9 hour?fter 9 hour

> hrs> hrs

F hrs *if needed+F hrs *if needed+

G>hrs *if needed+G>hrs *if needed+ %irst hour%irst hourHH (ontrast in lymph ducts(ontrast in lymph ducts

> hours> hours HH 0f lymph nodes0f lymph nodes


25/39

?fter 9 hourH?fter 9 hourH

LymphangiogramsLymphangiograms

the =rst =lms are takenthe =rst =lms are taken

usually of the lymphusually of the lymph

vesselsvessels the upper &ody orthe upper &ody or

any area of interest.any area of interest.

hese =rst ims are called hese =rst ims are called

ILymphangiogramsJKILymphangiogramsJK


26/39

LymphadenogramsLymphadenograms

> hours after the> hours after the

LymphangiogramsLymphangiograms

are taken the patientare taken the patient

has to come &ack tohas to come &ack to

have the =lms takenhave the =lms taken

of the lymphof the lymph nodesnodes

calledcalled

IlymphadenogramsKJIlymphadenogramsKJ

li &li &


27/39

upper lim&upper lim&

lymphographylymphography

in-ection of contrast agent in a collector ofin-ection of contrast agent in a collector of

dorsal radio5carpal surface *for super=cialdorsal radio5carpal surface *for super=cial

circulation+ or ulnar retro5styloid locationcirculation+ or ulnar retro5styloid location

*for deep circulation+*for deep circulation+

radiography of the lymphatic channels fromradiography of the lymphatic channels from

forearm to a)illary lymph nodesforearm to a)illary lymph nodes

Li & Li &


28/39

pper Lim&pper Lim&



29/39

Normal appearances andNormal appearances and

variationsvariations9.9. $ormal appearance of lymph nodes.$ormal appearance of lymph nodes.

a+a+ Lymphogram *=lling phase+' shows a homogeneousLymphogram *=lling phase+' shows a homogeneous

appearance of the lymph nodes.appearance of the lymph nodes.

&+&+ Lymphogram *nodal phase+' shows a smooth peripheralLymphogram *nodal phase+' shows a smooth peripheral

indentation *arrowheads+, which corresponds to the hilarindentation *arrowheads+, which corresponds to the hilar

area.area.

a) filling b) Nodal


30/39

4ara5aortic nodes have proved to4ara5aortic nodes have proved to

&e the most relia&le group for&e the most relia&le group for

showing features of highshowing features of high

diagnostic accuracydiagnostic accuracy

he cisterna chyli is usually a he cisterna chyli is usually a

saccular structure less than E cmsaccular structure less than E cm

in length usually lies at thein length usually lies at themidline of the &ody of L9 &ut maymidline of the &ody of L9 &ut may

also &e situated on either side ofalso &e situated on either side of

the midline.the midline. Lymphogram shows normal

cisterna chyli and the abdominalsegment of the thoracic duct.


31/39

he thoracic duct sharply merges into the -unction of he thoracic duct sharply merges into the -unction of

the left su&clavian vein and left internal -ugular veinthe left su&clavian vein and left internal -ugular vein

!ome rarely seen nodes are situated e)trinsically to!ome rarely seen nodes are situated e)trinsically to

the usual lymphographic regions, such as thethe usual lymphographic regions, such as the

popliteal, posterior intercostal, mediastinal, &ilateralpopliteal, posterior intercostal, mediastinal, &ilateral

hilar, paratracheal, and supraclavicular nodeshilar, paratracheal, and supraclavicular nodes

Figure: Lymphogram shows Normal

appearance of the thoracic duct. the termination

of the thoracic duct at the left subclavian-

jugular venous anastomosis at the base of the

neck

0li l i ti L h ti0li l i ti L h ti


32/39

0liopelvic5aortic Lymphatic0liopelvic5aortic Lymphatic

!ystem!ystem

0li l i ?&d i ti0li l i ?&d i ti


33/39

0liopelvic ?&dominoaortic0liopelvic ?&dominoaortic



34/39

0nguinal 2egion0nguinal 2egion


35/39


Lipiodol lymphography: Left image: fter the injection of contrast material

!lymphangiographic phase) the normal lymphatic vessels of the minor pelvis

are visuali"ed. #ight image: $% hours after the injection normal inguinal&

pelvic and paralumbar lymph nodes are demonstrated !nodal phase).


36/39

complicationscomplications

he ma-or complications of lymphography are he ma-or complications of lymphography are

caused &y the vital dye and contrast materialscaused &y the vital dye and contrast materials

rather than the techniuerather than the techniue Ma-or freuent complication'Ma-or freuent complication'

9.9. pulmonary oil em&oliationpulmonary oil em&oliation

>.>. 4ulmonary infarction4ulmonary infarction

.. hypersensitivity to methylene &lue dye andhypersensitivity to methylene &lue dye and

ethiodied oilethiodied oil

2are complication'2are complication'

9.9. intraalveolar hemorrhageintraalveolar hemorrhage

>.>. hypothyroidismhypothyroidism

.. systemic arterial em&oliation to the &rain orsystemic arterial em&oliation to the &rain or

kidneykidney


37/39

4ost 4rocedure4ost 4rocedure

9.9. 7atch for signs of infection7atch for signs of infection

!welling red and warm to touch!welling red and warm to touch

?ccompanied &y a fever?ccompanied &y a fever

(ontact D2 right away(ontact D2 right away

>.>. Drink lots of waterDrink lots of water

.. Ma-or swelling in one lim&Ma-or swelling in one lim&

1specially lim& in-ected1specially lim& in-ected


38/39

(onclusion(onclusion

his procedure has largely &een replaced &y non5 his procedure has largely &een replaced &y non5

invasive M20 or ( procedures.invasive M20 or ( procedures.

Cowever, lymphography has the uniue capa&ilityCowever, lymphography has the uniue capa&ility

of demonstrating internal architecturalof demonstrating internal architectural

derangements within normal5sied lymph nodes.derangements within normal5sied lymph nodes.

his highly valua&le advantage makes his highly valua&le advantage makes

lymphography diagnostically more accurate than (lymphography diagnostically more accurate than (

*which demonstrates sie rather than architecture+*which demonstrates sie rather than architecture+

Lymphography still has a cornerstone role inLymphography still has a cornerstone role in


39/39

3 ?N 3 ?N

lympografi lain

Documents