Sometimes it is necessary to examine the lymph nodes and the drainage paths around them. Reasons for this can be, for example, hardened or enlarged lymph nodes that require a closer look by an expert physician. The procedure used for this purpose is called lymphography (also lymphography).
What is lymphography?
Lymphography is a procedure used to look more closely at the lymph nodes. Lymphography is a method based on radiation diagnostics to visualize the lymphatic channels and nodes. Various substances are injected to improve visualization of the affected tissue. Various procedural techniques can be used for this purpose. In the meantime, this examination method has been almost completely superseded by sonography, MRI and CT. This is especially true for the purely diagnostic procedure. It is still used mainly for injuries in the lymphatic system caused by surgery or accidents, which cannot be localized in any other way. Poppy seed oil can in some cases lead to adhesion of the injury, so that further interventions are no longer necessary. Lymphography is therefore still suitable for certain medical questions. This also applies to cases in which computer tomography and magnetic resonance imaging have reached their limits. Other common names are lymphangiography or angiography of the lymphatic vessels.
Function, effect, and goals
Lymphatics in the limbs and lymph node images near the aorta and in the axillary and lumbar regions can be imaged using lymphography. In addition to injuries, various diseases can be studied using this procedure. These include lymphedema, which particularly affects the main trunk, as well as tumors in the lymph node area. Edemas are congestions with fluid accumulation that lead to discomfort. In the area of tumors, on the one hand, there is the possibility of daughter tumors (metastases) originating from other cancers. On the other hand, there may also be lymphomas. Other rarer diseases of the lymphatic system can also be detected by lymphography in some cases. The examination is a contrast medium examination, which is also suitable for checking the healing process of a previous injury. Lymphography is necessary, for example, if fluid accumulates in the chest area as a result of an injury. The medical profession refers to this as a so-called chylothorax. Depending on the amount of fluid, the functions of the heart and lungs may be impaired. Another possibility is the accumulation of fluid in the pericardium or abdomen. Tumors, on the other hand, trigger enlargement and hardening of the respective lymph nodes. While pain is often delayed, in some cases sufferers complain of more non-specific symptoms such as fatigue, night sweats and fever. Weight loss and decreased performance are also possible.Other imaging techniques that complement lymphography may be useful for diagnosis. These include normal X-rays, ultrasound, as well as the aforementioned CT scan or MRI. If tumor disease is suspected, the attending physician will also take a biopsy. Lymphography is one of the methods used to make a differential diagnosis. The procedure of lymphography is fixed. The patient is advised to lie down for a long time and should be fasting, otherwise there is a risk of anaphylactic shock. Medicine distinguishes between direct and indirect lymphography. In direct lymphography, a contrast medium is injected into the back of the foot to make the vessels visible. This procedure is performed with a very fine needle under local anesthesia. The lymphatic vessels absorb the dye and carry it away, making the pathways recognizable. During the injection and at further intervals up to 32 hours after the procedure, the lymphatic pathways are imaged via X-ray. Another option is double X-ray: once immediately after the procedure and another time about 24 hours later. In indirect lymphography, a dye is injected under the patient’s skin and transported through the tissue lymph to the surrounding lymph nodes and ducts. This makes them visible on X-ray. This procedure is used primarily for inflammatory diseases.
Risks, side effects and dangers
Lymphography is generally a low-risk procedure. Nevertheless, side effects or complications may occur. Often, lying down for long periods of time during the injection is considered uncomfortable. Therefore, it is advisable to have distraction options such as music or a book at hand. In rare cases, the medication that is injected into the affected person can cause allergic reactions. A less dangerous but disturbing side effect is a possible discoloration of the skin and urine due to the injected dye, but this subsides after a few days. A blue discoloration remains on the dorsum of the foot for up to two weeks after direct lymphography. Infections of the injection site are very rare, as are anaphylactic reactions. If the administered medication enters the lung cavity, a dry irritating cough may occur. In severe cases, this may progress to pneumonia. Other possible complications include the occurrence of headache, nausea and an increase in body temperature. In addition, nerve damage or scarring may occur in some cases. Radiation exposure from X-rays is extremely low. Here, the exposure depends on the number of images taken and amount of activity administered. Other imaging procedures have a similar radiation exposure. Only magnetic resonance imaging does not use ionizing radiation. Lymphography has the advantage of being more accurate than ultrasound or CT. In addition, it is particularly suitable for the early detection of lymph node metastases, even if they are not enlarged. Nevertheless, the examination is very time-consuming and is now rarely used. Therefore, the number of physicians who are proficient in it is decreasing. In addition, the procedure is quite prone to error, which means that it is only of limited value.