Norm of Lymphangiography (Lymphography, Lymphangiogram)
Normal-sized vessels and nodes containing no filling defects.
Usage of Lymphangiography (Lymphography, Lymphangiogram)
Indicated in clients with edema of lower extremities with unknown cause, Hodgkin's disease, lymphadenopathy, lymphoma, prostate cancer, testicular malignancy, tumor metastatic to the lymphatic system. Used to stage clients with lymphoma, demonstrate the extent and level of lymphatic metastasis, and evaluate the effectiveness of chemotherapy or radiation therapy. Used in conjunction with fine-needle aspiration to obtain biopsy of suspected cervical malignancy. Largely replaced by CT for evaluation of the retroperitoneal lymph nodes, but is still used if CT results are inconclusive.
Description of Lymphangiography (Lymphography, Lymphangiogram)
Radiographic test of the lymphatic vessels and lymph nodes. A radiopaque iodine contrast oil, such as Ethiodol, is injected into the lymphatics of the foot or hand. The dye remains in the lymph nodes for 6 months to 1 year; thus repeat plain x-rays films can be performed for follow-up of disease progression or to determine the effectiveness of the cancer treatment.
Professional Considerations of Lymphangiography (Lymphography, Lymphangiogram)
Consent form IS required.
Allergic reaction to dye (itching, hives, rash, tight feeling in the throat, shortness of breath, bronchospasm, anaphylaxis, death); renal toxicity from contrast medium; lipid pneumonia (e.g., contrast dye causes micropulmonary emboli); lymphangiitis; infection or cellulitis.
Previous allergy to iodized oil, iodine preparations, contrast dye used in other x-ray tests, or shellfish are relative contraindications. If allergies exist, the radiologist may prescribe a diphenhydramine and steroid preparation, which may be given before the procedure. Then a hypoallergenic, nonionic contrast medium will be used during the test. Other contraindications: severe chronic lung diseases, pregnancy (because of radioactive iodine crossing the blood-placental barrier), pulmonary insufficiency, cardiac disease, and severe renal or hepatic disease.
- Have emergency equipment readily available.
- See Client and Family Teaching.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- In the radiology department, the client is positioned supine on the examination table.
- An oil-based dye is injected intradermally between each of the first three toes of each foot to outline the lymphatic vessels. (The stain can also be injected into the web of the skin between the fingers.)
- Under local anesthesia, a 1- to 2-inch incision is made in the dorsum of each foot (or hand) about 15–30 minutes later.
- The lymphatic vessel is identified. This will be easily visualized after the stain is absorbed.
- A 30-gauge lymphangiographic needle with polyethylene tubing is carefully inserted into the identified lymphatic vessel. A low-rate infusion pump is used to administer an extremely low-pressure, slow injection (1–1.5 hours) of iodine contrast material.
- The flow of iodine dye is followed by fluoroscopy.
- When the contrast material reaches the level of the third and fourth lumbar vertebrae, the injection is stopped. This usually occurs in about 1½ hours.
- Radiographs are then taken of the chest, abdomen, and pelvis. This will demonstrate the filling of the lymph nodes.
- The cannula is removed, and the incision is closed with sutures after the injection of contrast is completed. The entire procedure takes about 3 hours.
- A second set of x-ray films is often made in 24–48 hours.
- Elevate legs to prevent swelling for 24 hours if prescribed. Keep the client on bed rest for 24 hours or as prescribed.
- Assess for signs of oil embolism every 4 hours for 24 hours (such as dyspnea, pain, and hypotension).
- Observe injection and incision sites for evidence of cellulitis (such as redness, drainage, swelling, pain). Monitor temperature every 4 hours for 48 hours after the procedure.
- The dressing is usually not changed for the first 48 hours.
- Allow the client to rest after the procedure.
- Monitor for complications, such as delayed wound healing or infection at the site of the incision or injection; edema of legs; allergic dermatitis; headache; sore mouth and throat; skin rashes; transient fever; lymphangitis; or oil embolism, which could occur if the contrast medium causes micro pulmonary emboli and could produce lipid pneumonia.
Client and Family Teaching
- No fasting or sedation is required.
- Discomfort may be felt when the stain is injected and when the feet are anesthetized.
- It is important to lie very still during the injection of the contrast dye. X-ray filming usually takes about 30 minutes.
- The dye will turn the urine and stool blue for 48 hours. Also, IV administration of the lymphatic stain or excessive infiltration of the stain may impart a transient bluish tint to the entire skin surface.
- Inspect the injection and incision sites for redness, swelling, and pain if the client will be returning home after the procedure.
- Sutures should be removed 7–10 days after the test.
Factors That Affect Results
- Inability to cannulate lymphatic vessels.
- To visualize axillary and supraclavicular nodes, injections are made in each hand.