lymphangiography

Lymphangiography is a radiographic procedure used to image the lymphatic system after injection of a contrast agent. It aims to visualize lymphatic vessels and nodes from peripheral channels through the cisterna chyli to the thoracic duct.

Techniques include pedal lymphangiography, where oil-based contrast such as Lipiodol is injected into a lymphatic vessel in the foot, followed by serial radiographs; and intranodal lymphangiography, in which contrast is injected directly into a lymph node, typically under ultrasound guidance. Fluoroscopic, CT, or MR guidance may be used to track contrast flow and map anatomy.

Indications include evaluation of lymphedema to identify obstruction, assessment of chylous effusions (chylothorax, chylous ascites) and thoracic duct leaks, and nodal mapping prior to reconstructive procedures such as lymphatic bypass or lymphovenous anastomosis. It can provide detailed anatomic information about lymphatic pathways that complements other imaging methods.

Therapeutically, oil-based lymphangiography with Lipiodol can occasionally help seal lymph leaks and contribute to resolution of chylous effusions, although this is not the primary goal in many cases and outcomes vary.

Compared with lymphoscintigraphy or MR lymphangiography, conventional lymphangiography offers high-resolution anatomical detail but is more invasive and carries risks associated with contrast administration. Complications can include oil embolism, inflammatory reactions, infection, and procedure-related injury to lymphatic vessels. The technique is now used primarily in specialized centers.