Lymphangiogram

A lymphangiogram is employed as a diagnostic tool to identify and localize lymphatic leaks, which occur when lymphatic vessels are damaged or disrupted, leading to the leakage of lymphatic fluid into surrounding tissues. The primary lymphatic vessel, known as the thoracic duct, transports lymphatic fluid from tissues and organs like the liver and intestinal tract back into the bloodstream. Damage to this duct, congenital anomalies, or elevated venous pressures may lead to disruptions in lymphatic flow, causing leakage of lymphatic fluid into the chest, abdomen, or other bodily cavities. Pre-diagnostic tests such as CT or dynamic contrast MR lymphangiography are used to diagnose a lymphatic leak.

 

During a lymphangiogram procedure, a contrast agent is injected into the lymphatic vessels, allowing visualization of the lymphatic system using fluoroscopy. Once a lymphatic leak is identified, a lymphatic embolization can be performed.  This is a minimally invasive procedure aimed at blocking or sealing off the leaking lymphatic vessels to restore normal lymphatic flow and prevent further leakage.

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In lymphatic embolization, embolic agents are introduced into the affected lymphatic vessels to occlude or block them, thereby stemming the flow of lymphatic fluid through the leak. These embolic agents can include substances such as ethyl vinyl alcohol copolymer (Onyx), glue (n-butyl cyanoacrylate), or coils, which are delivered via catheter-based techniques under imaging guidance. Once deployed, these embolic agents create a physical barrier within the lymphatic vessels, effectively sealing off the leak and promoting the resolution of symptoms associated with the lymphatic leak.

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Lymphatic embolization has demonstrated promising results in the treatment of various conditions associated with lymphatic leaks, including chylous ascites, chylothorax, lymphedema, and lymphatic malformations.

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