Lymphangiography: forgotten tool or rising star in the diagnosis and therapy of postoperative lymphatic vessel leakage.
Since the advent of computed tomography, numbers and expertise in Lymphangiography (LAG) have markedly dropped. The intention of our study was to demonstrate the persisting diagnostic and therapeutic impact of LAG on the postoperative patient with known or suspected lymphatic vessel leakage. Between May 1, 1999, and April 30, 2006, we investigated pedal lipiodol-LAGs (18 monopedal, 2 bipedal) on 22 patients (16 male, 6 female) with known or suspected postoperative chylothorax, chylaskos, lymphocele, or lymphatic fistula. Ages varied from 26 to 81 years. The spectrum of operative procedures was broad: 6 thoracic, 5 abdominal, and 11 peripheral operations were performed. In 20 patients who underwent mono- or bipedal LAG for lymphatic vessel injury, we were able to demonstrate the specific site of leakage in 15 cases (75%) and found signs of extravasation in 5 patients (25%). Furthermore, in 11 patients (55%) we were able to avoid surgery because of closure of the leak after LAG. As the conservative therapeutic approach usually takes 2-3 weeks to reveal its therapeutic effects, 73.3% (11/15) of the patients who were not reoperated before this hallmark was passed did not need any further operation. Our study clearly demonstrates that even in the decades of modern cross-sectional imaging, classic LAG is a powerful and highly reliable tool to visualize and even assist occlusion of the postoperatively damaged lymphatic vessel and may thereby avoid the need for reoperation.
Kos
Sebastian
S
Institute of Radiology, Kantonsspital Aarau, 5001 Aarau, Switzerland. skos@gmx.de
Haueisen
Harald
H
Lachmund
Ulrich
U
Roeren
Thomas
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002916:Chylothorax / Q000000981:diagnostic imaging; D003287:Contrast Media; D005119:Extravasation of Diagnostic and Therapeutic Materials; D005260:Female; D005402:Fistula / Q000000981:diagnostic imaging; D006801:Humans; D007459:Iodized Oil; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging* / Q000293:injuries; D008210:Lymphocele / Q000000981:diagnostic imaging; D008220:Lymphography; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000628:therapy; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy
D003287:Contrast Media; D007459:Iodized Oil