Lymphangiography

Blood flows through the body through blood vessels (arteries, capillaries and veins). There are also fine (very small) vessels that carry a fluid called lymph, which is a clear-yellow fluid that is important in the body’s immune system and in the digestion of fats. Lymph vessels carry lymph fluid to veins, where it is reabsorbed into blood. The thoracic duct is the main lymph vessel; it carries lymph fluid from the lower body and intestinal tract back into the blood stream. Injury to the duct or a congenital abnormality can result in the collection of lymph in the chest or abdomen, which can lead to difficulty with breathing. Lymphangiography is the use of X-ray to visualize the body’s lymphatic system. (This is also referred to as lymphangiography, or a lymphangiogram.)

About this Treatment

About this Treatment

How do we perform a lymphangiography?

A physician injects a tiny amount of blue dye between the toes and makes a small incision on the top of one or both feet. Using live X-ray (fluoroscopy), the doctor tracks the dye to identify a tiny lymphatic vessel in the foot and inserts a needle into this vessel. The doctor slowly injects a special dye and watches it flow upward through the lymphatic system. Once the dye reaches the thoracic duct in the upper abdomen, the doctor inserts a needle into the duct (usually through the abdomen).

The doctor places a tiny tube (catheter) inside the duct, and injects X-ray dye (contrast) to find the leak.

The leak is sealed through a procedure called thoracic duct embolization. The doctor injects tiny metal coils and/or special glue through the catheter. These coils and glue block the leak.

The foot incision is stitched closed and bandaged.

Will my child be awake for the procedure?

No. We will use IV sedation or general anesthesia so that your child is asleep.

How long does the procedure take?

This procedure generally takes two to four hours.

What are the risks of lymphography?

The procedure is considered low-risk. However, potential complications include:

  • Bleeding
  • Infection
  • Injury to the liver
  • Injury to the aorta
  • Inability to find a lymph vessel in the foot
  • Inability to successfully puncture the thoracic duct
  • Continued chest lymph drainage despite a technically successful procedure
Pre and Post Operative Care

Pre and Post Operative Care

How do my child and I prepare for the procedure?

We encourage good communication between you and your child, including the necessity and overview of the procedure as well as ensuring them that you are close by the whole time. Holding them or their hands until they leave for the procedure is a great way to provide support.

You will be given specific instructions along the way but you may need to arrive a few hours before the scheduled procedure to have some blood tests done. When you arrive at the hospital, a doctor will review the procedure and associated risks, after which you will sign a consent form. When we are ready to get started with the procedure, a nurse will place an intravenous line to deliver sedating medications and you will be allowed to accompany your child in the operating room until they are asleep, after which you will be escorted to a waiting room.

What should I expect after the procedure is complete?

After the procedure is complete, your child will need to lie on his or her back in the recovery area for one hour to minimize the chance of having a headache. Then your child will be able to go home or return to his or her hospital room.

When can my child bathe?

We will place a Band-Aid® or clear bandage and gauze over the site. Keep the area dry for 24 hours. After 24 hours, you may remove the bandage and your child may shower or take a bath as usual.

Are there any activity restrictions?

Though your child can resume normal school-going or daycare attendance, physical activity that can result in pulling of the tube should be limited, particularly contact sports and rough playing.

CONTACT CNMC IMMEDIATELY IF YOUR CHILD EXPERIENCES ANY OF THE FOLLOWING:

•     Redness, pain, swelling, or bruising at the needle insertion site.

•     Fever higher than 101o Fahrenheit or 38o Celsius.

•     A change in color or temperature to the associated extremity.

•     Numbness, swelling, or pain of the associated extremity.

The department of Interventional Radiology can be reached at: 202-476-3791, Monday through Friday, between 8 a.m. and 5 p.m.

At all other times please call 202-259-8643, which is the on-call pager. Follow the instructions and wait for a call back.

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