LYMPHANGIOGRAM- RTECH 255 NOTES SPRING 2007
refer to Merrills Vol3 & Pathology Book Pg 274 -275
& CIRCULATORY SYSTEM – CH 8
Considered to be part of the circulatory system
2 PART OF CIRCULATORY SYSTEM – BLOOD AND LYMPHATICS
Lymph filters bacteria, carbon particles and malignant cells – like vessels, flow goes towards the heart
LOOK AT – ANATOMY GROUPS of lymph nodes
LYMPHOMAS :
signs and symptoms: enlarged lymph nodes, itching, fever, night sears, fatigue weight loss.
risk factors: unknown – reduced immune function and increased risk of exposure to infectious agents.
HIV pts at higher risk for NHL. Occupational exposure to herbicides and other chemicals.
treatment: chemotherapy and radiation therapy combined (possible bone marrow transplant)
HISTORY OF :Hodgkins lymphoma : cancers that involve the lymph nodes
Lymphoma – can be applied to entire spectrum of malignant diseases (note all lymphomas are
malignant)
Comprise approx 3% -4% of all malignant diseases in humans
can occur at any age group lymphomas are closely related to some forms of leukemia
2 catagories : Non- Hodgkins lymphomas (NHL) & Hodgkin’s disease
Hodgkin's disease (HD) and non Hodgkin's lymphomas (NHL) - which together are called lymphomas - are types of
cancer. Cancer is not one condition but a word applied to many different diseases, which have diverse causes and a
wide range of treatments.
LYMPHOMAS
61,000 new cases in 2002 of Non- Hodgkin’s lymphomas (NHL) & Hodgkin’s disease
Non- Hodgkin’s lymphomas (NHL) 7,000
Hodgkin’s disease – 54,000
(has doubled since 1970’s)
1 year survival rate is 93%
92-98 new cases stabilized
Hodgkin's lymphoma is a malignancy
EXCEPT among black females
(cancer) of lymph tissue found in the lymph
overall beginning to decline
nodes, spleen, liver, and bone marrow.
1 year survival rate is 75%
HODGKIN’S DISEASE HD
a form of malignant lymphoma that is pathologically distinct from other lymphoid diseases
affects all age groups peaks at age 25 and age 55
Non-Hodgkin's lymphomas NHL
are cancers of lymphoid tissue (lymph nodes, spleen, and other organs of the immune system).
History of Hodgkins lymphoma
Cancers that involve the lymph nodes
Lymphoma – can be applied to entire spectrum of malignant diseases
Comprise approx 3% -4% of all malignant diseases in humans
can occur at any age group
HODGKINS
Non-Hodgkin's lymphomas
The cause is not known
The incidence is 3 in 10,000 people.
The incidence is 2 in 10,000 people
lymphomas are closely related to some
Hodgkin's lymphoma is most common
forms of leukemia
among people 15 to 35 and 50 to 70 years
old
HODGKIN’S DISEASE staging:
I – only 1 lymph node involved / II - 2 or more, same side as diaphragm
III – both sides of diaphragm
IV – widespread involvement
CHILDHOOD DISEASES
Childhood cancer : Non- Hodgkin’s lymphomas – 4%
Hodgkin’s disease 4.5%
may also invade bone marrow and other organs (spleen, thymus) may cause selling in lymph nodes
of the neck axilla and groin / general weakness and fever
Lymphangiogram – radiographic investigation and demonstration of the lymphatic system
CT and U/S ?? PET SCANS??
have been used to successfully stage tumors – replacing lymphangiograms
CT usually first procedure in staging, esp NHL – abnormal CT replaces lymphangiograms
Lymphangiograms - most value with Hodgkin’s disease - (no bulky masses seen, alteration of
internal architecture which cannot be detected with CT) also aids when CT is equivocal.
The CT scan, the gallium scan, or the MRI or PET scans may be used instead.
CT SCANNING Still procedure of choice for staging of Hodgkin’s lymphoma *
Procedure
Patient prep Empty bladder, long procedure (4-5 hours) over 2 days
Special attention to patient’s physiological needs (Ca pt)
Small cut-down made on top of foot ( see diagram in snopeck)
Slow injection of 5 – 10 ml/extremity @ 1.25 h
Room – radiographic (usually does not need fluoroscopic
Filming –
Chest / abdomen / pelvis poss extremities – 24 hours –Shows lymph vessels and nodes
Follow up 48 and 72 hour films shows nodes
Normal should not have contrast after 24 hours
RADIOGRAPHIC FINDINGS:
Mediastinal lymph nodes enlargement is the most common radiographic findings in lymphoma. Seen
with about 1/3rd with NHL and ½ with Hod Lymp
involvement of the pulmonary parenchyma and pleura usually occur due to the mediastinals lymph
node enlargement. – RADIOGRAPHS may appear as a coarse interstitial pattern or solitary or
multiple ill-defined nodules or as patchy areas of infiltrates
Pleural effusion occurs in 1/3 of the patients - extension of the tumor into the pericardium can cause
pericardial effusion.
5 – 10 % have involvement of the GI tract (stomach and small bowel) – seen as large bulky polypoid
mass
Contrast Media – Ethiodol and lipiodal
Directly injected into a vessel of an extremity –
Blue dye used (METHELYLENE BLUE) – absorbed by lymphatic vessel –
Oil based usually used for lymphangio
Water based is irritating to the lymphatic system – causes pain and burning to patient
CONTRAINDICATIONS to exam
Known sensitivity to iodine
Advanced pulmonary disease
Undergoing radiation therapy (at least 3 weeks wait)