Lymphangiography

What is lymphangiography?

Lymphangiography is a special imaging test that creates pictures of your lymphatic system. The test involves an injection of dye (lipoidal) so that imaging technology can see lymphatic structures. Healthcare providers may use X-ray or MRI. If MRI is used, the technique is called magnetic resonance (MR) lymphangiography.

The lymphatic system is part of the human immune system and circulatory system. It includes a network of vessels that carry lymph around your body. Lymph is a clear liquid that acts as a filter throughout your body, collecting excess fluid and waste. The lymphatic system also includes lymph nodes, glands that produce cells to fight infections.

Lymphatic structures aren't visible with regular imaging tests. Lymphangiography uses dye with imaging technology to create lymphangiograms, pictures of the lymphatic vessels and lymph nodes.

The test is also called lymphography.

What is the purpose of lymphography?

Healthcare providers use lymphangiography to:

• Diagnose disease in your lymphatic system.
• Find out whether the disease has spread.
• Guide treatment, helping healthcare providers find the most effective places to administer treatments.
• Map your lymphatic system in preparation for surgery or intervention.
• Show whether treatments are working.

The test can help diagnose and manage conditions like:

• Lymphatic leak or injury.
• Lymphedema.
• Hodgkin lymphoma.
• Non-Hodgkin lymphoma.

Who performs a lymphangiography?

Lymphangiography is often done by an interventional radiologist. This type of doctor specializes in medical imaging and minimally invasive procedures to diagnose and treat disease.

How do I prepare for lymphangiography?

Your healthcare provider will give you specific instructions on how to prepare for the test. They may include:

• Avoid eating and drinking for several hours beforehand.
• Go to the bathroom to empty your bladder just before the test.
• Inform your healthcare provider if you might be pregnant or if you have any bleeding problems.
• Take medicine to help you relax.
• Tell your healthcare provider if you’ve ever had any allergic reactions to other medical procedures or iodine.
• Tell your provider if you have a history of cardiac disease — especially patent foramen ovale (PFO).

The test is sometimes done at the same time as a lymph node biopsy. In that case, your healthcare provider may give you anesthesia to prevent pain.

What should I expect during lymphangiography?

Your healthcare provider asks you to sit or lie down on an exam chair or table. Then they clean an area of skin and inject a small amount of blue dye. You might feel a sting during the injection.

The most common injection sites are:

• Near your groin (most common).
• Between your fingers (less common).
• Between your toes (less common).

The dye starts to cause blue lines, which highlight the lymph channels. The healthcare provider injects medicine into one of the blue areas to numb it. They make a small incision in the area and insert a thin, flexible tube.

More dye is injected through the tube for about an hour. You may feel some pressure as the dye flows into your body.

Sometimes the healthcare provider uses ultrasound to guide tube placement. And sometimes a pump called an insufflator helps push dye into your body.

Next, the healthcare provider uses a special type of X-ray called fluoroscopy or an MRI machine to take pictures inside your body.

The machine projects images of your lymphatic system onto a screen. This helps ensure that the dye is circulating throughout your body.

Once the dye is injected and circulating, your healthcare provider removes the tube and stitches up the incision. Then they take pictures of your legs, pelvis, abdomen, chest and other areas of potential concern. They may take more images the next day.

What can I expect after lymphangiography?

The incision site might be sore for a few days after lymphangiography.

You may have slightly discolored skin, pee and poop until the dye is mostly out of your system. However, some dye can remain in your lymph nodes for as long as two years.

What are the risks of lymphangiography?

Lymphangiography is generally safe. The test uses radiation, like any X-ray. But radiation exposure is too small to cause problems. If symptoms occur, they may include:

• Allergic reaction.
• Bleeding.
• Infection.
• Inflammation (swelling) of the lymphatic vessels.

When should I know the results of lymphangiography?

Your healthcare provider can often interpret the results of lymphangiography the same day. Sometimes they may even perform treatment during the lymphangiography itself. But a team of specialists might review and discuss the results together, such as the interventional radiologist and oncologist (cancer specialist).

Your healthcare provider will discuss the results with you and what they mean. If dye can’t get through an area, that might indicate a blockage, such as a tumor, injury or infection. Enlarged lymph nodes that look foamy may mean lymphatic cancer.

When should I call my healthcare provider after lymphangiography?

After the test, call your healthcare provider if you have any signs of allergic reaction or infection, such as:

• Fever or chills.
• Pain.
• Skin rash, such as redness or swelling.

A note from Cleveland Clinic

Lymphangiography is a special X-ray that takes pictures of your lymphatic system. It helps healthcare providers diagnose and manage diseases such as lymph cancer, swelling and infection. Your healthcare provider will help you understand the reasons you need the test and the results.