title: Intranodal lymphangiography: feasibility and preliminary experience in children.
abstract: OBJECTIVE
  To review an initial experience studying the lymphatic system using direct injection of ethiodized oil contrast medium into lymph nodes (ie, intranodal lymphangiography) in children with chylous disorders.
  
  
  METHODS
  Children with chylous disorders who underwent intranodal lymphangiography were included in this retrospective study. Under general anesthesia, ultrasonography was used to guide the placement of a small-bore (22-25-gauge) needle into an inguinal lymph node. Ethiodized oil contrast medium was very slowly injected into the node. Opacification of the lymphatic system was documented with fluoroscopic and digital substraction imaging and videofluoroscopic clips.
  
  
  RESULTS
  Five children (age range, 6 wk to 17 y) with chylous vaginorrhea (n = 1), postoperative chylothorax (n = 2), or spontaneous chylothorax (n = 2) underwent intranodal lymphangiography. The amount of ethiodized oil injected was 0.5-4.5 mL. Intranodal lymphangiography was successfully completed in four patients. One procedure was terminated because of patient motion and extravasation of contrast medium. Lymphangiographic findings included a spectrum of lymphatic channel disorders including incompetence, obstruction, collateralization, chylous reflux, and chylous leak. There were no complications.
  
  
  CONCLUSIONS
  The simplified technique of injecting contrast medium into a lymph node to opacify the lymphatic system in children can be an alternative to the more elaborate conventional lymphangiography.
authors.affiliation: Division of Vascular and Interventional Radiology, Children's Hospital Boston and Harvard Medical School, Boston, MA 02215, USA.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Rajebi
authors.forename: Gulraiz
authors.initials: G
authors.lastname: Chaudry
authors.forename: Horacio M
authors.initials: HM
authors.lastname: Padua
authors.forename: Brian
authors.initials: B
authors.lastname: Dillon
authors.forename: Sabri
authors.initials: S
authors.lastname: Yilmaz
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Arnold
authors.forename: Mary F
authors.initials: MF
authors.lastname: Landrigan-Ossar
authors.forename: Ahmad I
authors.initials: AI
authors.lastname: Alomari
mesh_terms: D000293:Adolescent; D000768:Anesthesia, General; D001900:Boston; D002648:Child; D002675:Child, Preschool; D002916:Chylothorax / Q000000981:diagnostic imaging*; D003287:Contrast Media; D004998:Ethiodized Oil; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007223:Infant; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging*; D008220:Lymphography / Q000379:methods*; D008297:Male; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011856:Radiographic Image Enhancement; D015641:Radiography, Interventional; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; D004998:Ethiodized Oil