Radiology

Lymphography and Thoracic Duct Embolization

Read this information so you understand the procedure and its risks. Please ask questions about anything you do not understand.

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What is lymphography?

Blood flows through the body through blood vessels (arteries, capillaries and veins). There are also fine (very small) vessels that carry a fluid called lymph, which may look clear or yellow. (You’ve probably seen lymph fluid if your child has had a cut or a pimple.)

Lymph vessels carry lymph fluid to veins, where it is reabsorbed into blood. The thoracic duct is the main lymph vessel; it carries lymph fluid from the lower body and intestinal tract back into the blood stream. Injury to the duct or a congenital abnormality can result in the collection of lymph in the chest or abdomen, which can lead to difficulty with breathing.

Lymphography is the use of X-ray to visualize the body’s lymphatic system. (This is also referred to as lymphangiography, or a lymphangiogram.)

How is lymphography done?

A physician injects a tiny amount of blue dye between the toes and makes a small incision on the top of one or both feet.

Using live X-ray (fluoroscopy), the doctor tracks the dye to identify a tiny lymphatic vessel in the foot and inserts a needle into this vessel. The doctor slowly injects a special dye and watches it flow upward through the lymphatic system. Once the dye reaches the thoracic duct in the upper abdomen, the doctor inserts a needle into the duct (usually through the abdomen).

The doctor places a tiny tube (catheter) inside the duct, and injects X-ray dye (contrast) to find the leak.

The leak is sealed through a procedure called thoracic duct embolization. The doctor injects tiny metal coils and/or special glue through the catheter. These coils and glue block the leak.

The foot incision is stitched closed and bandaged.

Will my child be awake for the procedure?

No. We will use IV sedation or general anesthesia so that your child is asleep.

How long does the procedure take?

This procedure generally takes two to four hours.

What are the risks of lymphography?

The procedure is considered low-risk. However, potential complications include:

Will my child have pain after the procedure?

This generally is not a painful procedure. Some children feel pain in the foot or upper abdomen where needles are placed. You may give over-the-counter pain medications.

What should I expect after the procedure?

Your child will return to his or her room. Your child will have blue-green urine for a few days as the body eliminates the dye. The stitches will be removed in seven to 10 days.

How long will the bandage be in place?

The gauze and clear bandage should remain in place for three to four days. After a parent or nurse removes the bandage, keep the stitches open to the air. (Don’t put another bandage on.)

When can my child bathe?

It’s OK to sponge-bathe your child while the bandage is on, as long as it remains dry. After the bandage is removed, your child may shower. Don’t submerge the site in water (bath or pool) until the stitches are removed.

Are there any activity restrictions?

Your child may wear sneakers or comfortable shoes and may resume activities such as school or day care. Your child shouldn’t run, play contact sports or engage in activities that may pull the stitches. Once they are out, your child may resume all activities.

 

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Appointments

Contact us immediately if your child experiences any of the following:

  • fever higher than 101° Fahrenheit
  • swelling in the leg
  • redness, swelling, bleeding and/or drainage such as pus around the stitches

Call Interventional Radiology
between 8 a.m. and 4:30 p.m., Monday through Friday,
at 215-590-7000. At the first prompt push 1 and at the second prompt push 2.

At all other times, call 215-590-1000 and ask to speak to the interventional radiologist on call.