Diagnostic lymphangiography

The lymphatic system is complex; its imaging remains challenging because it links different structures together that can be involved in a wide variety of congenital, neoplastic, and infectious diseases. Lymphangiography is the radiographic demonstration of the lymphatic system by injection of contrast material. The earliest attempts at indirect lymphangiography were made by injection of radiopaque material into subcutaneous tissue with uptake in the adjacent nodes. Direct injection into large palpable nodes, or lymphadenography, was also demonstrated. In 1955, the technique of lymphangiography was developed to study lymphedema of lower extremities. Given to the important role of lymphangiography in lymphatic interventions, such as thoracic duct embolization, as well as development of new contrast agents and imaging techniques such as magnetic resonance (MR) lymphangiography, contrast-enhanced ultrasound, and positron emission tomography, the field of lymphatic imaging is growing. The purpose of this chapter is to review the procedural elements of traditional bipedal lymphangiography with stepwise illustration of the interventional radiologic technique.