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Introduction ⬇

A lymphangiogram, also known as lymphangiography, examines the lymphatic channels and lymph nodes by means of radiopaque iodine contrast injected into the small lymphatics of the foot. This test is commonly ordered for patients with Hodgkin disease or cancer of the prostate to check for nodal involvement. A lymphangiogram is also indicated to evaluate edema of an extremity without known cause, to determine the extent of adenopathy, to stage lymphomas, and to localize affected nodes as part of surgical or radiotherapeutic treatment.

Procedure ⬆ ⬇

  1. Place the patient in the supine position on the x-ray table.

  2. After injection of a local anesthetic agent, inject a blue contrast subcutaneously between each of the first three toes of each foot to stain the lymphatic vessels 15 minutes before the start of the examination.

  3. Make a 1- to 2-inch incision on the dorsum of each foot after the site is infiltrated with local anesthetic agent.

  4. Identify and cannulate the lymphatic vessel to facilitate extremely low-pressure injection of the iodine contrast medium over a 30-minute period.

  5. Discontinue the injection when the contrast medium reaches the level of the third and fourth lumbar vertebrae as seen on fluoroscopy.

  6. Observe that abdominal, pelvic, and upper body images demonstrate the lymphatic vessels filling.

  7. Obtain a second set of images 12–24 hours later to demonstrate filling of the lymph nodes.

  8. View the nodes in the inguinal, external iliac, common iliac, and periaortic areas, as well as the thoracic duct and supraclavicular nodes, using this procedure.

  9. Evaluate the axillary and supraclavicular nodes after injecting lymphatics in the hand.

  10. Perform repeat studies, as indicated, as the contrast dye remains present in the nodes for several months after lymphangiography. Repeat studies can track disease activity and monitor treatment without the need to repeat contrast injection. The patient may need to have additional images taken.

  11. Follow guidelines in Chapter 1 for safe, effective, informed intratest care.

Clinical Implications ⬆ ⬇

Abnormal lymph node and vessel x-ray results may indicate the following conditions:

  1. Retroperitoneal lymphomas associated with Hodgkin disease

  2. Metastasis to lymph nodes

  3. Abnormal lymphatic vessels

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain test purpose and procedure. Obtain or confirm a signed, witnessed informed consent form.

  2. Follow iodine contrast test precautions.

  3. Assess pregnancy status of female patients. If positive, advise the radiology department.

  4. Tell the patient that no fasting is necessary and usual medications can be taken.

  5. Instruct the patient that they may feel some discomfort when the local anesthetic agent is injected into the feet.

  6. Administer oral antihistamines per healthcare provider orders if allergy to the iodized contrast agents is suspected.

  7. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Clinical Alert

  1. Lymphangiography is usually contraindicated in the following conditions:

    1. Known iodine hypersensitivity

    2. Severe pulmonary insufficiency

    3. Cardiac disease

    4. Advanced kidney or hepatic disease

  2. The major complication of this procedure relates to contrast media embolization into the lungs. This will diminish pulmonary function temporarily and, in some patients, may produce lipid pneumonia. The patient may require aggressive respiratory management if this complication is life-threatening.

  3. If the patient has diabetes and is taking metformin, special considerations may be necessary. Consult with the radiology department to determine whether this medication regimen must be discontinued the day of and several days after the study.

  4. Assess whether the patient is allergic to latex and inform the radiology department of any known or suspected sensitivities before study.

  5. Assess whether the patient is allergic to iodine. If iodine contrast sensitivities are known or suspected, inform the radiology department before study.

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed.

  2. Check and record the patient’s temperature every 4 hours for 48 hours after the examination.

  3. Provide a restful environment.

  4. If ordered, elevate the legs to prevent swelling.

  5. Watch for complications such as delayed wound healing, infection, extremity edema, allergic dermatitis, headache, sore mouth and throat, skin rashes, transient fever, lymphangitis, and oil embolism.

  6. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Reference Values ⬆

Normal

Normal lymphatic vessels and nodes