Lymphography (X-ray-lymphography) is an x-ray examination of the lymphatic system after introduction of radiopaque substances into the previously colored lymphatic vessels. B. Ya. Lukyanchenko for clinical lymphography recommends the vital staining of lymphatic vessels by subcutaneous injection of 1 ml of 0.25% Evans bluegrade solution on novocaine in the first interdigital space of the foot or third hand. After anesthesia 3-5 cm proximally from the site of the introduction of blue eyes, the skin is opened up to the subcutaneous tissue, which is usually well visible in a dark blue colored lymphatic vessel. The latter is released from the surrounding tissues and punctured with a thin needle, which is fixed in the lumen of the vessel with a ligature. The needle is connected with a transitional cannula by a polyethylene tube with a 20-gram syringe, reinforced in a mechanical device that allows the slow introduction of a contrast agent (Figure 1).
Fig. 1. A mechanical device for the introduction of an oil contrast medium and a transitional cannula (according to B. Ya. Lukyanchenko).
For lymphography use oil contrast media (iodolipol, etiodol, etc.), as well as water-soluble (diodone, urografine, etc.). For lymphography of the lower limb, 7-8 ml is sufficient, the top - 3-4 ml of iodolipol, which is administered at a rate of 1 ml for 15 min. Radiography in three projections is performed immediately after administration (early lymphogram) and after 24-48 hours. (late lymphograms).
Early lymphograms are used to study the state of lymphatic vessels (the lymph nodes are not completely contrasted), on late lymph nodes (normally the vessels are free of contrast medium by this time).The
Normal lymphatic vessels of limbs are relatively straightforward with lymphography, they have the same caliber (1-1.2 mm), clear and even contours, contain circular constrictions corresponding to the valves. Lymph nodes have the form of rounded, oval or bean-shaped formations with smooth and distinct contours ranging in size from 0.5 to 2 cm with a uniform finely mottled structure (sine nodes). With lymphography, the following groups of lymph nodes are normally detected: inguinal, external and general iliac, lumbar, axillary, partially supra- and subclavian.
Lymphography makes it possible to clarify the morphological and functional state of the lymphatic system.
With nonspecific lymphadenitis, the lymph nodes are enlarged in size, they have even and clear contours, the structure is finely mottled. In malignant diseases of the lymphatic system (lymphogranulomatosis, lymphosarcoma, reticulosarcoma, chronic lymphocytic leukemia), the lymph nodes are significantly enlarged in size, have smooth and distinct contours, coarse-grained structure. With metastases of cancer in the lymph nodes, the main radiographic evidence is the filling defect, which is formed as a result of replacement of the sine node by the tumor. The shape and size of the filling defect are different; Metastasized sites are usually enlarged in size. With extensive metastatic damage, normal lymph circulation is disturbed, manifested in the expansion of the leading and absence of the draining lymphatic vessels (block), in the rupture of the chain of lymph nodes, the development of collateral lymphatic circulation, in the long delay (more than 48 hours) of iodolipol in the lymphatic vessels (Figure 2).
Lymphography allows you to clarify the extent of the spread of the tumor process, to outline a rational treatment plan, to facilitate the removal of lymph nodes during surgery, and also to monitor the effectiveness of radiotherapy.
Lymphography is performed in a hospital for medical reasons.
Fig. 2. Two-sided late lymphogram with cervical cancer. Defects of filling in the lymph nodes of the external and general iliac groups; delay of contrast agent in the leading lymphatic vessels.