Name of the Procedure:

Lymphangiography, extremity only, bilateral
(Alternatives: Lymphatic imaging, Lymphatic X-ray)

Summary

Lymphangiography is an imaging procedure used to visualize the lymphatic vessels and nodes in both extremities. It involves the injection of a contrast dye and the use of X-rays to capture detailed images. This procedure is supervised and interpreted by a radiologist.

Purpose

Lymphangiography helps diagnose and evaluate conditions affecting the lymphatic system, such as lymphedema, lymphatic blockages, or certain cancers. The goal is to obtain clear images of the lymphatic vessels and nodes to guide treatment decisions.

Indications

• Chronic swelling in the arms or legs (lymphedema)
• Suspected lymphatic blockages
• Assessment of the extent of lymphatic spread of cancer
• Evaluation of lymphatic malformations or leaks
• Criteria: Persistent, unexplained swelling, or lymphatic abnormalities detected by other imaging modalities.

Preparation

• Patients may be advised to fast for a few hours before the procedure.
• Medications may need to be adjusted, especially blood thinners.
• Pre-procedure blood tests may be required to check kidney function and coagulation status.
• Patients should inform the healthcare provider of any allergies, especially to contrast dye or iodine.

Procedure Description

1. The patient lies down, usually on an X-ray table.
2. A small amount of local anesthetic is applied to numb the injection site, typically in the feet.
3. A contrast dye is injected directly into the lymphatic vessels in both extremities.
4. X-rays are taken as the dye travels through the lymphatic system, highlighting the vessels and nodes.
5. The radiologist supervises and interprets the images as they are captured to ensure all necessary views are obtained.

Duration

The procedure typically takes about 1 to 3 hours, depending on the complexity and the patient's condition.

Setting

Lymphangiography is performed in a hospital's radiology department or an outpatient imaging center equipped with specialized X-ray equipment.

Personnel

• Radiologist: Supervises, performs, and interprets the procedure.
• Radiologic technologist: Assists with the imaging process.
• Nurse: Provides patient care before, during, and after the procedure.
• Anesthesiologist: May be involved if sedation is required.

Risks and Complications

• Common: Mild pain or discomfort at the injection site, allergic reaction to contrast dye, temporary swelling.
• Rare: Infection, bleeding, blood clots, severe allergic reactions, contrast-induced nephropathy.

Benefits

• Provides detailed images of the lymphatic system.
• Helps diagnose and guide the treatment of lymphatic disorders.
• Can identify blockages, malformations, and the extent of disease spread.

Recovery

• Patients are usually observed for a short time after the procedure.
• Instructions include rest and avoiding strenuous activity for 24 hours.
• Monitoring the injection site for signs of infection or severe reactions.
• Follow-up appointments may be scheduled to discuss results and further treatment.

Alternatives

• Ultrasound: Less detailed but non-invasive.
• MRI or CT scans with contrast: Provide different views and detail levels.
• Each alternative varies in terms of detail, invasiveness, and cost, and should be discussed with a healthcare provider.

Patient Experience

• During the procedure: Possible discomfort from the injection, mild pressure as the dye is injected.
• After the procedure: Some swelling or bruising at the injection site, mild pain or discomfort manageable with over-the-counter pain relievers.

Pain management and comfort measures are provided throughout the procedure to ensure the patient is as comfortable as possible.