A lymphangiogram is an imaging study performed to visualize the lymphatic system, which plays a crucial role in immune function and maintaining fluid balance in the body. This test is often employed when there is suspicion of lymphatic abnormalities, such as lymphedema, chylothorax, or the spread of malignant cancers to lymph nodes. As a cardiovascular ICU intensivist, I’ll occasionally encounter chylothorax that remains refractory to dietary modification and time. I’ll consult my interventional radiology colleagues to perform this study to look for blockages, leads, or irregular patterns.
In the case of chylothorax, a groin lymph node is accessed with an injection of lipiodol (an oil-based, radio-opaque contrast agent). With an anterior, transabdominal approach, the cisterna chyli is accessed with a microcatheter threaded into the thoracic duct. In the following video, one can visualize severe lymphatic ectasia with contrast terminating at torturous right hilar and peribronchial lymphatics.
In recent years, newer techniques such as MR lymphangiography and SPECT-CT have emerged, offering enhanced resolution without the need for iodinated contrast. These modalities allow more detailed and complete visualization of the lymphatic system.
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