Lymfangiografie

Lymfangiografie (lymfangiografie) is a radiologic imaging procedure used to visualize the lymphatic system by injecting a contrast medium into lymphatic vessels. Traditionally this required cannulation of a lymphatic vessel in the foot (pedal lymphangiography) to outline peripheral lymphatics and regional lymph nodes. Modern techniques commonly employ a less invasive approach, such as intranodal lymphangiography, where contrast is injected under ultrasound guidance directly into an inguinal lymph node.

Technique: A radiopaque contrast agent, often oil-based (Lipiodol) or other iodinated contrast, is introduced and serial radiographs, fluoroscopy, or cross-sectional imaging track the flow through lymphatic channels. The intranodal method uses ultrasound to guide injection into a superficial lymph node, enabling visualization with lower technical risk than pedal cannulation. The procedure requires expertise to locate and cannulate lymphatic vessels and to manage potential complications.

Indications: evaluation of suspected lymphatic disorders such as primary or secondary lymphedema, identification of lymphatic leaks after surgery or trauma, investigation of chylous effusions or chylothorax, and localization of abnormal lymphatic channels in lymphangiomatosis. It can help plan surgical or interventional management. In some settings lipiodol lymphangiography may have a therapeutic effect by promoting scarring of leaks, though this is variable and case-dependent.

Risks and limitations: potential complications include oil embolism, infection, vessel damage, allergic reactions to iodinated contrast, and radiation exposure. The procedure is technically demanding and not always feasible. Noninvasive alternatives, such as MR lymphangiography or CT lymphangiography, are increasingly used to evaluate the lymphatic system without cannulation.