Lymphography: Complications Encountered in 522 Examinations

Abstract

Lymphography, despite some difficulties in performance and uncertainties in interpretation, has become accepted and is being more and more widely used in the clinical investigation of numerous diagnostic problems. I t is a valuable procedure in the staging of lymphomas, the search for metastases in cases of known carcinoma, and the elucidation of puzzling clinical problems. The best demonstration of both lymphatic vessels and nodes is achieved by the injection of Ethiodol,2 a contrast material with an oil vehicle. The medium eventually finds its way into the blood stream, either via the cisterna chyli and thoracic duct (Fig. 1) or, occasionally, via lymphaticovenous anastomoses (Fig. 2). In addition to the usual complications of intravascular introduction of foreign materials, including allergic reactions, the medium might be expected to cause difficulty because of microembolization consequent on its physical properties (Fig. 3). In practice, in our hands the side-effects have been minimal and have not caused us to alter our policy of performing the study on outpatients when indicated. Almost half our initial 522 examinations were performed on this basis. The purpose of this paper is to discuss the complications arising from the intralymphatic injection of Ethiodol as encountered in a large series. Material and Methods Lymphography was performed in 522 patients in the interval November 1959 to March 1965 either at the University of Texas M.D. Anderson Hospital and Tumor Institute in Houston or at the Methodist Hospital of Indiana, Indianapolis. The selection of material rested entirely in the hands of the clinicians of the institutions involved. The majority of patients harbored a malignant tumor of some type; the remainder, with a few exceptions, presented diagnostic problems in which malignant tumor entered as one of the differential diagnoses. The exceptions were a few patients studied because of peripheral edema. No premedication or special preparation is used routinely. Prior to the study the procedure is discussed with the patient. The possible complications are indicated. The outpatient is given a printed set of instructions indicating the measures to be taken should untoward reactions occur. The more serious reactions encountered were manifested before the patient left the Department, and no emergent situations requiring home visits or admission to hospital have occurred. The complications were assessed in three ways: first, by direct questioning of the patient at the initial and follow-up studies; second, by perusal of the patient's hospital chart; finally, in 200 examinations, by a questionnaire filled out by the patient at the time the twenty-four-hour films were obtained. In addition, such pathologic material as was available either at surgery or autopsy was studied for both immediate and delayed effects of the foreign material on the tissues.