title: Transnodal lymphangiography in the diagnosis and treatment of genital lymphedema.
abstract: OBJECTIVE
  To report the success of groin nodal lymphography in the diagnosis and treatment of genital lymphedema.
  
  
  METHODS
  We present one female (8 years old [patient no. 1]) and two male (69 and [patient no. 2] 31 years old [patient no. 3], respectively) patients with genital lymphedema in whom conservative treatment failed. The girl also had lymphorrhagia. Genital lymphedema was caused by radical cystectomy (patient no. 2), lymphatic hyperplasia (patient no. 1), and idiopathic lymphangitis (patient no. 3). All of them underwent ultrasound-guided bilateral groin lymph node puncture. Afterward, 4-8 ml Lipiodol Ultra-Fluide (Guerbet) were injected at a rate of 0.2 ml/s. Lipiodol progression was assessed by fluoroscopy. Computed tomography scan of the abdomen and pelvis was performed immediately after and again at 24 h after the procedure to confirm the leak. The follow-up period was 15, 13, and 9 months, respectively. Technical success was considered as bilateral pelvic and abdominal filling of lymphatic vessels. Therapeutic success was considered as improvement or disappearance of genital lymphedema and/or lymphorrhagia.
  
  
  RESULTS
  Lipiodol leak to the scrotum was observed in patients no. 2 and 3. Lymphaticopelvic fistula and genital lymphatic hyperplasia were seen in patient no. 1. Genital lymphedema diminished within 1 week and almost disappeared in two cases (patients no. 1 and 3) or significantly improved (patient no. 2). lymphorrhagia also resolved in patient no. 1. No recurrence or worsening was detected during follow-up.
  
  
  CONCLUSIONS
  Therapeutic lymphangiography by lymph node injection seems to be effective to treat genital lymphedema. Lymph node puncture lymphangiography is feasible and less cumbersome than pedal lymphangiography.
authors.affiliation: Servicio de Radiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain. gomez_fermun@gva.es
authors.forename: F M
authors.initials: FM
authors.lastname: Gómez
authors.forename: J
authors.initials: J
authors.lastname: Martínez-Rodrigo
authors.forename: L
authors.initials: L
authors.lastname: Martí-Bonmatí
authors.forename: E
authors.initials: E
authors.lastname: Santos
authors.forename: I
authors.initials: I
authors.lastname: Forner
authors.forename: M
authors.initials: M
authors.lastname: Lloret
authors.forename: D
authors.initials: D
authors.lastname: Pérez-Enguix
authors.forename: R
authors.initials: R
authors.lastname: García-Marcos
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D003937:Diagnosis, Differential; D004998:Ethiodized Oil; D005260:Female; D005471:Fluoroscopy; D005831:Genital Diseases, Female / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D005832:Genital Diseases, Male / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008209:Lymphedema / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D008220:Lymphography / Q000379:methods*; D008297:Male; D011677:Punctures; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional
chemical_list: D004998:Ethiodized Oil