Abstract
Intranodal lymphangiography (IL) a recently introduced technique provides a diagnostic and therapeutic method of lymphatic disorders. The benefits of this technique include reduced technical difficulty and shorter procedure duration, as compared to traditional pedal lym-phangiography (PL). The scope of this lecture is to understand the fundamentals and advanced techniques of performing lymphangiography as well as important points for safe and proper use of Lipiodol®.
[Intranodal lymphangiography] The original procedure of IL first described in 1952 by Bruun et al. is characterized by a direct puncture of enlarged lymph nodes under palpation. As it was not performed under ultrasound guidance, the indications for IL were limited and less preferred than PL. However, the circumstances changed after 45 years when Rajebi et al. and Nadolski et al. reported the effectiveness of IL in the pediatric field; they started to perform IL under US guidance, and since then, IL has become popularized as a simple method for evaluation and intervention of lymphatic disorders.
[Direct Puncture Retrograde Thoracic Duct Access] This technique is an alternative method of thoracic duct (TD) intervention first reported in 2016 by Carlos J. et al. It is characterized by direct insertion into the venous system at the base of the left neck during lymphangiography or US guidance. This technique is especially useful to visualize the terminal portion of the TD, which is located between the internal jugular vein and the left vertebral vein. The superficial location of the TD and the high accuracy in identifying the TD in the left neck under US guidance provides sufficiently high visibility to access the TD under iodine-based lymphan-giography. Thus, this method is safely applicable for cases with right-left shunt without taking the risk of systemic embolization.
