What is lymphography?

Lymphography is the use of X-ray to visualize the body’s lymphatic system. (This is also referred to as lymphangiography, or a lymphangiogram.)

In our bodies, there are very small vessels that carry fluid called lymph, which may look clear or yellow. (You’ve probably seen lymph fluid if your child has had a cut or a pimple.)

Lymph vessels carry lymph fluid to veins, where it is reabsorbed into blood. The thoracic duct is the main lymph vessel. It carries lymph fluid from the lower body and intestinal tract back into the blood stream. Injury to the duct or a congenital abnormality can result in the collection of lymph in the chest or abdomen, which can lead to difficulty with breathing.

Procedure

A physician injects a tiny amount of blue dye between the toes and makes a small incision on the top of one or both feet.

Using live X-ray (fluoroscopy), the doctor tracks the dye to identify a tiny lymphatic vessel in the foot and inserts a needle into this vessel. The doctor slowly injects a special dye and watches it flow upward through the lymphatic system. Once the dye reaches the thoracic duct in the upper abdomen, the doctor inserts a needle into the duct (usually through the abdomen).

The doctor places a tiny tube (catheter) inside the duct, and injects X-ray dye (contrast) to find the leak.

The leak is sealed through a procedure called thoracic duct embolization. The doctor injects tiny metal coils and/or special glue through the catheter. These coils and glue block the leak.

The foot incision is stitched closed and bandaged.

This procedure generally takes two to four hours.

Anesthesia

Patients receive either IV sedation or general anesthesia and are asleep for this procedure.

Risks

The procedure is considered low-risk. However, potential complications include:

• bleeding
• infection
• injury to the liver
• injury to the aorta
• inability to find a lymph vessel in the foot
• inability to successfully puncture the thoracic duct
• continued chest lymph drainage despite a technically successful procedure

Pain

This is generally not a painful procedure. Some children feel pain in the foot or upper abdomen where needles are placed. You may give over-the-counter pain medications if your child has discomfort following the procedure.

After the Procedure

Your child will return to his or her room. Your child will have blue-green urine for a few days as the body eliminates the dye. The stitches will be removed in seven to ten days.

The gauze and clear bandage should remain in place for three to four days. After a parent or nurse removes the bandage, keep the stitches open to the air. (Don’t put another bandage on.)

Bathing

It is fine to sponge bathe your child while the bandage is on, as long as it remains dry. After the bandage is removed, your child may shower. Don’t submerge the site in water (bath or pool) until the stitches are removed.

Activity Restrictions

Your child may wear sneakers or comfortable shoes and may resume activities such as school or day care but should not run, play contact sports or engage in activities that may pull the stitches. Once the stitches have been removed, your child may resume all activities.