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• W1985654994 abstract "Lymphangiography, the radiographic demonstration of the lymphatic system by intralymphatic injection of contrast material, has opened a new field of investigation. Earlier attempts at indirect lymphography were made by injection of radiopaque material into the subcutaneous tissue with uptake in the adjacent nodes (1). Direct injection into large palpable nodes, lymphadenography, was introduced by Carvalho in 1931 (6, 26, 31). Kinmonth in 1955 developed lymphangiography as a method of study of lymphedema of the lower extremities (20). Hreshchyshyn and Sheehan recently modified this approach (13). We have utilized the procedure with only minor variations to study the dynamics of the lymphatic system and the abnormalities in the nodes in various disease states. We have correlated our findings in man with those of animal investigations as summarized by Drinker, Yoffey, and Courtice (8, 29). Our investigation was initiated at Jefferson Medical College Hospital and later extended to include the group at Philadelphia General Hospital. Method The method of lymphangiography to be described here applies to both the upper and lower extremities. Half a milliliter (0.5 ml.) of a mixture containing equal parts of 0.5 per cent Evans blue dye and 1 per cent procaine hydrochloride is injected intradermally into the interdigital web space between the first and second or fourth and fifth digits of the extremity. The procaine hydrochloride is added to minimize the transitory pain which occurs when the dye is injected alone. The blue dye is selectively absorbed by the lymphatics, making them readily identifiable within fifteen to thirty minutes (Fig. 1). At that time, with aseptic technic, a small skin incision is made proximal to the injection site and a lymphatic conveying the blue dye is identified and isolated. An untied ligature is placed around the vessel proximally to obstruct and distend it temporarily (Fig. 2). A small, narrow-gauge needle (25 to 30 depending on lymphatic size), which has previously been fitted to a polyethylene tube, is then threaded into the vessel and secured in place by a ligature. Ethiodol, an ethyl ester of poppyseed oil containing 37 per cent iodine, is placed in a syringe connected by an adapter to the polyethylene tubing, and low and constant pressure is applied to the syringe by means of a “C-clamp” apparatus, which is manually driven (Fig. 3). The contrast material is thus slowly forced into the lymphatic system. Best and most extensive visualization is achieved when injections are prolonged over a period of an hour and a half to two hours, at a rate of approximately 7 ml. per hour. Undue pressure may cause extravasation of the contrast material into the soft tissues of the extremity. We generally use 5 to 7 ml. of radiopaque material in the upper extremity and 10 to 15 ml. in the lower extremity, not exceeding a total of 25 ml. if both legs are injected." @default.
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• W1985654994 date "1961-02-01" @default.
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• W1985654994 title "Lymphangiograms: Their Diagnostic and Therapeutic Potential" @default.
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• W1985654994 doi "https://doi.org/10.1148/76.2.179" @default.
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