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General Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rebecca Fish, Aisling Hogan, Aoife Lowery, Frank McDermott, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Yew-Wei Tan, Thomas Tsang
Contrast lymphangiography: An invasive procedure where patent V blue dye is injected into the affected hand/foot to identify the lymphatic vessels. The vessels are then cannulated and injected with a radiopaque contrast medium to allow radiological imaging.
The Lymphatic/Immune System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
The lymphatic system can be visualized by injecting radiopaque dyes into the lymphoducts and then taking roentgenograms of the individual. Roentgenographic visualization of the lymphoducts and lymph nodes is called lymphography. If the vessels are primarily visualized, the procedure is referred to as lymphangiography. Lymphadenography is visualization of the lymph nodes.
Miscellaneous procedures
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Lymphangiography is another imaging technique that can be used to demonstrate the lymphatic system. The procedure will visualise the subcutaneous vessels of the leg, corresponding to the saphenous vein and then accompanying the iliac vessels and the aorta until they drain into the cisterna chyli. The cisterna chyli in turn drains into the thoracic duct, which lies on the spine behind the aorta and eventually drains into the left subclavian vein.
The application of indocyanine green (ICG) and near-infrared (NIR) fluorescence imaging for assessment of the lymphatic system in reconstructive lymphaticovenular anastomosis surgery
Published in Expert Review of Medical Devices, 2021
Albert H. Chao, Steven A. Schulz, Stephen P. Povoski
One limitation of ICG lymphangiography is that it may only identify some but not all functional subcutaneous lymphatic vessels that are present. It has been observed that some subcutaneous lymphatic vessels are non-ICG-enhanced but demonstrate lymphatic flow (flow-positive) when viewed through the operative microscope[51]. This may occur in two particular situations. First, in more advanced lymphedema there may be some degree of dermal backflow, which can obscure functional subcutaneous lymphatic vessels that exist within that same underlying area. This effect can be reduced by visualizing the dye immediately after injection before dermal backflow occurs. Second, ICG lymphangiography involves surface visualization of fluorescence which penetrates up to approximately 1.5–2.0 cm below the skin, and thus it does not capture deeply located but functional subcutaneous lymphatic vessels that could be candidates for LVA. Due to these limitations, some investigators have recommended also using ultrasonography and laser tomography to identify subcutaneous lymphatic vessels [52,53]. These alternative imaging modalities are also useful in patients with an allergy to iodine.
Chylous ascites in cirrhosis from retroperitoneal lymphoma
Published in Baylor University Medical Center Proceedings, 2021
Rahul Hegde, Ayah Megahed, Prabin Sharma, Anas Bamashmos, Ian Karol
Diagnosis of chylous ascites without paracentesis might be very difficult. Our review of the literature showed isolated cases where chylous ascites was diagnosed due to detection of fat-fluid level on CT.4 Ultrasound would also show both serous and chylous ascites as anechoic and would not be able to differentiate them. The diagnosis, though, can be readily made by visual inspection of the milky white color of the ascites fluid and by detection of high triglyceride levels on laboratory analysis of the ascitic fluid. The role of imaging further lies in detecting the etiology of the chylous ascites. Abdominal imaging with ultrasound, CT, or magnetic resonance imaging (MRI) is appropriate to identify the presence of cirrhosis, abdominal and retroperitoneal masses, lymphatic malformations, or peritoneal infections. Direct imaging of the lymphatics—either fluoroscopic lymphangiography or MRI lymphangiography—is tricky and seldom performed.5 One advantage of direct imaging is that it may provide the exact location of disruption of the lymphatics, which then could be treated either by embolization6 or surgical repair.
Interventions in Congenital Heart Disease:A Review of Recent Developments: Part I
Published in Structural Heart, 2021
Recently, insights gained through magnetic resonance imaging (MRI) of the lymphatic system in the Fontan circulation have facilitated novel lymphatic interventions that may provide effective symptomatic relief. Dori et al first reported the usefulness of an MRI T2-weighted technique in detecting lymphatic abnormalities in a single ventricular circulation to direct management.84 Using this technique, the group found a greater extension and distribution of lymphatic channels in the chest and neck of patients after a superior cavopulmonary anastomosis, which correlated with poorer outcomes after planned Fontan completion surgery.85 More recently, dynamic contrast-enhanced magnetic resonance lymphangiography (DCMRL) involving gadolinium bilateral injection into the inguinal lymph nodes and image acquisition using time-resolved dynamic T1-weighted MRI has been applied in several case series of children and adults to guide targeted lymphatic intervention.86,87 In the largest series, in 16 of 18 children with surgically corrected CHD and PB, abnormal pulmonary lymphatic perfusion was identified by DCMRL. Subsequent intervention by lymphatic embolization or thoracic duct stenting with covered stents to exclude retrograde flow into the lungs resulted in significant improvement of symptoms and often cessation of PB cast formation without significant complications.87 Further, Maleux et al reported selective embolization of hepato-duodenal lymphatics to treat PLE in 7 Fontan patients. The dilated periportal lymph vessels were punctured under ultrasound guidance, with the location confirmed by injection of contrast and occluded with a mixture of Lipiodol and n-butyl cyanoacrylate, resulting in improvements in quality of life and normalization of albumin levels after the intervention. Complications including spillage of glue in portal branch, transient cholangitis, and caustic duodenal bleeding were self-limiting.88