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Lymphangiogram

(Lymphangiography)

A lymphangiogram is a type of X-ray that is used to look at the lymph nodes and lymph vessels — structures that make up your child's lymphatic system.

Illustration of the immune system
The Immune System - Click to Enlarge

The lymphatic system is responsible for producing white blood cells that fight infection. The procedure is also called lymphangiography.

About the procedure

The lymphatic system does not show up on a normal X-ray of the body. Because of this, a technician will inject what is known as a contrast medium, typically a blue dye, before the procedure to make parts of the lymphatic system show up better.

Lymphangiograms are rarely used today. In most instances when the lymphatic system needs to be observed, doctors now often prefer to use CT scans.

Reasons for the procedure

A lymphangiogram may be used for a child who has cancer. It is typically done along with a lymph node biopsy to help the child's health care provider determine if the cancer has spread to another part of the body.

These are other reasons to perform a lymphangiogram:

  • To determine if a particular cancer therapy is effective

  • To evaluate the cause of swelling in an arm or leg

  • To look for disease caused by parasites

  • To determine if the child has Hodgkin's disease or non-Hodgkin's lymphoma

Risks of the procedure

The main risks of a lymphangiogram are from a potential reaction to the dye. These reactions could include:

  • Fever

  • Inflammation of the lymph vessels

  • Infection

  • Another allergic reaction related to the dye

The dye can also cause some pain when it is injected, and it can turn the child's skin slightly blue. The child might even comment that things he or she sees look a little bluish, too. The color can also appear in urine or stool for about two days. In rare instances, the dye can stay in the lymph nodes for up to two years.

There is some risk for radiation exposure from X-rays, but most experts feel that this is a relatively low risk.

Before the procedure

  • The child's health care provider will ask you to sign a form giving your consent for the procedure.

  • Make sure the child's health care provider knows about all medications, prescription and over-the-counter, that the child is taking.

  • Tell the health care provider if the child has had any problems with bleeding in the past.

  • Mention any allergies that the child has. Of particular importance is allergy to the dye that will be used.

  • The child will not be allowed to eat or drink for several hours before the procedure.

  • If a lymph node biopsy is also being done, additional steps must be followed beforehand as that is a surgical procedure.

During the procedure

A lymphangiogram may be performed on an outpatient basis or as part of a hospital stay. The steps of the procedure may vary, depending on the child's condition and the health care provider's practices. Generally, a lymphangiogram follows this process:

  • The child will probably be given a sedative to relax.

  • The child's feet will be cleaned, and then a small amount of dye will be injected in the webbing between two toes. This helps identify the lymph channels on the child's foot.

  • Once a lymph channel is found, a small incision will be made and a tube will be inserted into the channel. Dye will slowly flow through the tube into the lymphatic system for the next 60 to 90 minutes.

  • As the dye flows through the child's body, X-rays will be taken of various locations throughout the body.

  • Once the dye injection is complete, the tube will be removed and the incision will be closed with small stitches.

After the procedure

Results of the testing are usually available in 24 to 48 hours. If the procedure is done on an outpatient basis, you should be able to take your child home after a short observation period. The child may need to return at a later time to have the stitches removed.

You will need to watch the child closely for awhile to make sure he or she has no adverse effects from the injection of the dye. Contact the child's health care provider immediately if you notice any type of reaction.

The health care provider will give you specific instructions regarding movement and care of the child's foot, pain medication, symptoms to watch for, and any activity restrictions. It's likely that you will need to make sure the child rests his or her foot for at least several hours after the procedure.

As far as food is concerned, you should be able to give the child whatever he or she likes best as soon as you get home. Diet restrictions are not common after this procedure.