Dr. ABEER FAWZY EL SOBKY Master Degree In Radiodiagnosis Lymphography Dr. ABEER FAWZY EL SOBKY Master Degree In Radiodiagnosis

Nephrostomy Placing a catheter directly into the kidney to drain urine in situations where normal flow of urine is obstructed. NUS catheters are nephroureteral stents which are placed through the ureter and into the bladder

Radiologically Inserted Gastrostomy Placement of a feeding tube percutaneously into the stomach and/or jejunum

Vertebroplasty Percutaneous injection of biocompatible bone cement inside fractured vertebrae

localized destruction of tissue by freezing Cryoablation localized destruction of tissue by freezing

Biopsy Taking of a tissue sample from the area of interest for pathological examination from a percutaneous or transjugular approach

TIPS Placement of a Transjugular Intrahepatic Porto-systemic Shunt (TIPS) for management of select patients with critical end-stage liver disease and portal hypertension

Radiofrequency ablation (RF/RFA) localized destruction of tissue (e.g., tumors) by heating

Biliary intervention Placement of catheters in the biliary system to bypass biliary obstructions and decompress the biliary system. Also placement of permanent indwelling biliary stents

These minimally invasive procedures involve less blood loss. CONCLUSIONS Interventional radiology procedures are an advance in medicine that often replace open surgical procedures. These minimally invasive procedures involve less blood loss.

Lymphography

Function of lymphatic system It provides an important pathway for drainage of fluid from cells and tissues back to the bloodstream It is a vital part of the immune system

Components of lymphatic system: Lymphatic trunks lymph nodes : N.B. There are lymphatics within most body tissues (e.g. Lymphatics are not present in brain, spinal cord).

Anatomy

Anatomical considerations Lymphatic trunks accompany arteries & veins Para-aortic lymphatic trunks empty into the cisterna chyli (L2 level) Passing up through the diaphragm to become the thoracic duct Terminates by anastomosing with the left subclavian vein. Smaller right lymphatic trunk drains into the right subclavian vein.

Anatomical considerations Valves within the lymphatics The combination of filtration pressure movement of the limbs and muscles contraction of the smooth muscle fibers within the walls of lymphatic trunks. Lymph drainage is about 2.5 L/day.

Lymph nodes Ecapsulated aggregates of lymphatic tissue, Bean shaped In the path of the lymphatic vessels Size from microscopic to 2 cm Hilum Number approximately 600. Approximately 300 in the neck.

Disorders of lymphatic system Lymph ducts (ymphedema) Primary lymphedema: This is a vascular dysplasia Secondary lymphedema: obstruction to the normal forward passage of lymph

Lymph nodes Malignant involvement Lymph node enlargement due to infection.

Imaging of lymphatic system X ray US CT scan MRI Lymphography Lymphoscintigraphy

lymphography Sensitive test that studies the lymphatic ducts and the internal architecture of nodes Follow-up imaging of nodal diseases as the contrast persists in lymph nodes for 6-12 months.

Lymphography only examines lymph nodes and ducts in the drainage pathway from the legs or arms. Successful lymphography is a difficult procedure for patient and operator

Technique The small lymphatic ducts in the foot must be cannulated using a cut-down procedure; Oily contrast media is then slowly injected Radiographs taken Immediately After at least 24 h delay to demonstrate the lymph nodes.

lymphography for lymph vessels Injection of water-soluble radiological contrast media No LN opacification In most cases lymphography can be replaced by lymhangioscintigraphy.

The technique of lymphography in the edematous leg is difficult, and prior elevation of the limb for 48-72 h may help reduce the amount of limb edema.

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