In lymphongiography, a contrast dye is injected into lymph vessels in your feet or hands. Filled with dye, these vessels can be visualized on x-ray film. Continuous x-ray imaging, or fluoroscopy, is used to track the flow of dye through the lymphatic circulation; plain x-ray films are also obtained to record any abnormalities. Lymphangiography is especially useful for evaluating patients with suspected cancers of the lymphatic system, such as Hodgkin’s disease and non-Hodgkin’s lymphomas.
Purpose of the Lymphangiography
- To diagnose and determine the stage of lymphomas, and to identify metastatic cancer (spread from other areas of the body) involving the lymph nodes
- To evaluate the effectiveness of chemotherapy or radiation therapy for lymphomas
- To evaluate suspected cases of lymphedema—an accumulation of lymph fluids resulting in swelling of the arms and legs, which may be primary (caused by a lymph vessel defect of unknown origin) or secondary (caused by tumors, inflammation, infection, or removal of the lymph nodes)
Who Performs It
- A radiologist
- Pregnant women should not undergo this test because exposure to ionizing radiation may harm the fetus.
- People with allergies to iodine or shellfish may experience an allergic reaction to iodine-based contrast dyes.
- This test is not appropriate for people with severe chronic lung, heart, kidney, or liver disease because the lipid-containing contrast dye may further damage these organs.
- Because the dye remains in the lymph nodes for up to 2 years, subsequent x-rays can be used to assess the progress of any lymphatic disease and the effectiveness of treatment.
Before the Lymphangiography
- Inform your doctor if you have an allergy to iodine or shellfish. You may be given a combined antihistamine-steroid preparation to reduce the risk of an allergic reaction.
- You may be given a sedative before the test.
- Empty your bladder just before the test.
- You must sign a consent form.
- You will likely be asked to refrain from eating and drinking for several hours before the test.
- Tell the doctor if you are pregnant, have bleeding problems or have ever had negative/allergic reactions during or after an x-ray (to contrast material) or to iodine.
What You Experience
- You will lie on your back on an examination table.
- The skin on your feet is cleansed with an antiseptic, and a blue contrast dye is injected into the web of skin between several of the toes on both feet. (Less often, this is done between fingers in both hands instead.) These injections will cause a brief sting.
- After about 15 minutes, the lymphatic vessels will appear as small blue lines on the upper surface of the instep of each foot.
- A local anesthetic is then injected into both feet (this injection may cause brief discomfort). The doctors numbs the area, makes a small surgical cut into one of the larger blue lines, once the area is numb, a thin needle is inserted through a small incision into a lymphatic vessel in each foot; the needle is attached to a tube (cannula). Contrast dye is infused into the vessels at a slow rate; it usually takes 60 to 90 minutes for the infusion to be completed. Remain as still as possible during this time to avoid dislodging the needles.
- As the dye is being infused, its progress may be followed with fluoroscopy, which projects real-time x-ray images onto a viewing screen. The infusion is stopped when the dye reaches about waist level.
- The needles are removed, the incisions sutured closed, and sterile dressings are applied.
- Next, x-ray films are taken of your chest, abdomen, pelvis, and legs to demonstrate filling of the lymph nodes.
- The entire procedure usually takes about 3 hours.
- You must return in 24 hours so that additional x-ray films can be taken.
Risks and Complications
- Although radiation exposure is minimal, you receive a higher dose than during standard x-ray procedures.
- Possible complications include infection, fever, inflammation of the lymph vessel and lipoid (or lipid) pneumonia, which can occur if the contrast dye penetrates the thoracic duct and causes tiny pulmonary blood clots (emboli); these clots typically disappear after several weeks or months.
- Some people may experience an allergic reaction to the iodine-based contrast dye, which can cause symptoms such as nausea, sneezing, vomiting, hives, and occasionally a life-threatening response called anaphylactic shock. Emergency medications and equipment are kept readily available.
After the Lymphangiography
- You must rest in a hospital bed for 24 hours, with your feet elevated to help reduce swelling. Your vital signs will be monitored periodically and you will be observed for signs of complications.
- Ice packs can be applied to the incision sites to help reduce swelling, and you may be given a pain reliever.
- The blue dye may cause a bluish tinge to your skin and vision and may also discolor your urine and stool for 48 hours.
- Call your doctor if you notice redness, pain, and swelling at the infusion sites.
- Do not immerse your feet in water until the sutures have been removed—about 7 to 10 days after the procedure.
- A doctor will examine the x-ray films for evidence of any abnormality.
- If a definitive diagnosis can be made, appropriate treatment will be initiated, depending on the specific problem.
- In some cases, additional tests, such as a lymph node biopsy, may be needed to establish a diagnosis and determine the extent of the problem.
The Johns Hopkins Consumer Guide to Medical Tests
Simeon Margolis, M.D., Ph.D., Medical Editor
Updated by Remedy Health Media