Lymphography

Lymphography (rentgenografiya) - x-ray examination of the lymphatic system after the introduction of pre-painted lymphatic vessels rentgencontrastnykh substances. B. Ya. Lukyanchenko for clinical limfografii recommends vital staining lymph vessels subcutaneous injection of 1 ml of 0.25% solution of methylene blue Evans on novocaine first interdigital period of the foot or third - hand. After anesthesia for 3-5 cm proximal from the introduction of blue expose the skin to the subcutaneous tissue, which is usually visible painted in dark blue color lymphatic vessel. The latest release from the surrounding tissues and the dotted line with a fine needle, which is fixed in the vessel lumen ligature. The needle use the transition cannula connected to a plastic tube with a 20-gram syringe strengthened in mechanical device that allows you to slowly introduce the contrast agent (Fig. 1).

Fig. 1. A mechanical device for the introduction of oil contrast medium and transitional cannula (by B. Ya. Lukyanchenko).

For limfografii use oil contrast agent (yodolipola, ethiodol and others), and soluble (diodon, urographine and others). For limfografii lower limb enough 7-8 ml, top - 3-4 ml yodolipola, which is injected at a rate 1 ml 15 min. x-rays in three projections made directly after the introduction (early lipogram) and in 24-48 hours. (late lipogram).
In the early limbograph examined the state of the lymphatic vessels (lymph nodes are not fully contrastirovania), the later - lymph nodes (usually by this time the vessel is free from the contrast material).
Normal lymphatic vessels of the extremities when limfografii relatively straightforward, have the same caliber (1-1,2mm), clear and smooth contours, contain circular narrowing, the appropriate valves. Lymph nodes have a look round, oval or Bobovich formations with smooth and clear contours from 0.5 to 2 cm with a uniform melkobrat structure (the sinus node). When limfografii normal identifies the following groups of lymph nodes: inguinal, exterior and common iliac, lumbar, axillary, partly over - and subclavian.
Lymphography, you can check the morphological and functional state of the lymphatic system.
When nonspecific lymphadenitis lymph nodes are enlarged, have smooth and clear boundaries, structure melchorita. In malignant diseases of the lymphatic system (chlamydia, lymphosarcoma, retikulosarkoma, chronic lymphoblastic) lymph nodes significantly increased in size, have a smooth and transparent, coarse-grained structure. When cancer metastases in lymph nodes of the primary x-ray characteristic is filling defect, which is formed as a result of replacement swelling of the sinus node. The shape and size of defect filling there are different; metastases in nodes are usually enlarged. With extensive metastatic spread disrupted normal lymph circulation, expressed in the expansion of the leading and the absence of a discharge lymph vessels (unit), in breaking the chain of lymph nodes, the development of collateral lymph circulation, in a long time (more than 48 hours.) yodolipola in the lymph vessels (Fig. 2).
Lymphography allows you to specify the degree of dissemination of the tumor process, to outline the rational treatment plan, facilitate removal technique lymph node during surgery, and also enables to monitor the effectiveness of radiation therapy.
Lymphography is produced at the hospital on medical indications.

Fig. 2. Bilateral late limforum in cervical cancer. The filling defects in the lymph nodes outside and common iliac groups; delay of contrast in the afferent lymph vessels.