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LYMPHANGIOGRAMS RT 255 (rev 2010)/ 2014*

Lymphography & Lymphangiogram Disease Of The Lymphatic System. LYMPHANGIOGRAMS RT 255 (rev 2010)/ 2014*. * 2014 – Note Red Slide # - are ref to the 2010 lecture slides #’s. Lymphatic System: Green-superficial Black- deep. radiographic investigation and

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LYMPHANGIOGRAMS RT 255 (rev 2010)/ 2014*

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  1. Lymphography & Lymphangiogram Disease Of The Lymphatic System LYMPHANGIOGRAMSRT 255 (rev 2010)/ 2014* * 2014 – Note Red Slide # - are ref to the 2010 lecture slides #’s Lymphatic System:Green-superficialBlack- deep radiographic investigation and demonstration of the lymphatic system

  2. Lymph nodes are home to lymphocytes which help fight infections - They can become swollen if an infection is present • http://www.youtube.com/watch?v=qEIV6c61kx4&feature=related

  3. Lymphatic system:Considered to be part of the circulatory system 2 Parts of Circulatory System: Blood (Arteries/ Capillaries/ Veins) & Lymphatics • Lymph filters bacteria, carbon particles and malignant cells • like which other vessels that the direction of flow goes towards the heart?

  4. Lymphatic System

  5. Painless lump or swollen gland - enlarged lymph nodes itching, skin rash Drenching night sweats Fever (100º) , fatigue Unexplained weight loss (10%) Coughing or breathlessness Nausea, vomiting LYMPHOMAS : signs and symptoms Common Lymph Nodes: Adenoids Spleen Appendix Bone marrow Thymus Tonsils

  6. LYMPHOMAS : signs and symptoms • Check for metastasis • Edema in limbs • Obstruction • Infections • Rule out cancer • Looking for LYMPHOMA • Look for parasitic diseases • Find the cause for any unusual swelling in an extremity (obstruction)

  7. LYMPHOMA - risk factors • Unknown causes • Reduced/suppressed immune function • as a result of organ transplantation • HIV/AIDs pts at higher risk for NHL (50-100x) • increased risk of exposure to infectious agents • Occupational exposure to herbicides and other chemicals.

  8. History of Hodgkins lymphoma • lymphomas are closely related to some forms of leukemia 2 catagories  • Non- Hodgkins lymphomas (NHL) • & Hodgkin’s disease

  9. #11 Signs and symptoms   • The first sign of this cancer is often an enlarged lymph node which appears without a known cause • The disease can spread to adjacent lymph nodes and later may spread outside the lymph nodes to the lungs, liver, or bone marrow. • Main types of Lymphomas: • HD - spreads in a predicable way to each lymph group • NHL - are found in lymph nodes or lymphatic organs - the cause is not known • Mutations in certain genes

  10. Chest image shows contrast in the the largest lymph vessel in the body – the Throacic duct • Chest CT of a patient with non-Hodgkin's lymphoma (NHL) demonstrating a necrotic lymph node in the cardiophrenic angle.

  11. Lymphoma -Malignancy of lymphatic system #13 Either Hodgkin's or Non-Hodgkin's • Non-Hodgkin's The incidence is 3 in 10,000 people • related to some leukemia’s • Originate in parenchymal organs (40% extranodal / other areas) • 60 years of age (median) • 1 year survival rate is 75% • Hodgkin's The incidence is 2 in 10,000 people • 90% start in lymph nodes (10% extranodal) • 15-35 (40) years (HD peaks at 25 ) • Most common among people 15 to 35 and 50 to 70 years old • 2nd peak: mid to late 50’s / More men that women affected • 1 year survival rate is 93% • Can be imaged using x-ray, CT, MRI, PET, US and NM. • Modality of choice depends on location. • Lymphangiogramsrarely used to diagnosis this disease anymore

  12. #20 HODGKINS Who get’s it? • Age:  Hodgkin's Disease most often occurs in people 15 to 35 years old and in people over 55 years old. • Family History of Hodgkin's Disease:  Having a brother or sister with Hodgkin's Disease indicates that you may be at higher risk because of genetic factors. • Viruses:  People who have had an infection from the Epstein-Barr virus or who have had infectious mononucleosis ("mono") are at a higher risk. • Compromised Immune System:  AIDS, immune system suppressing drugs, and various immunodeficiency syndromes have been associated with an increased risk • COMPARE & REVIEW: • Non- Hodgkins: • 1. Common Age? 60 • 2. Survival Rate? HD = 93%NHL =75% • 3. Which one is more common _______ 2/10 K ______ 3/10K H/nhl

  13. Hodgkins Disease and Non Hodgkins Lymphoma – What’s the Difference? #25 • In Hodgkins disease the biopsy contains a type of cell called a Reed-Sternberg cell. • This type of cell is notpresent in non Hodgkins lymphoma. • There are quite a lot of different non Hodgkins lymphoma types.

  14. treatment #26 • However, all lymphomas are treated either by radiotherapy or chemotherapy and, in some instances, both. • The treatment given depends on the exact diagnosis so one person’s treatment may be different to another’s

  15. Non-Hodgkin’s Lymphoma #31 • CT of abdomen & pelvis is used to stage disease • Treatment consists of chemo and/or Rad therapy • Symptoms vary • Lymphadenopathy • anemia • Hepatomegaly • Splenomegaly • Fever and weakness

  16. Non-Hodgkin’s Lymphoma #32 XRAY- shows enlarged lymph nodes along mediastinum. CT, MRI and PET can demonstrate lymphoma in almost any organ. US is used for retroperitoneal adenopathy. NM: gallium has an increased intake in affected nodes.

  17. Case study:Hodgkin’s Disease #33 • CT exams show enlarged retroperitoneal nodes • Symptoms • Painless lymph node swelling in cervical area • Fever • Fatigue • Anemia & weight loss • Coughing • breathlessness

  18. Hodgkin’s Disease #35 Treatment includes RAD therapy And chemotherapy Symptoms include malaise, fever, Anorexia, enlarged lymph nodes

  19. Staging of Lymphomas #35 • Stage I: • One lymph node group • Only one part of a tissue • One organ • Stage II: • Two lymph node groups on the same side • one part of a tissue or an organ and the lymph nodes near that organ • In other lymph node groups on the same side of the diaphragm • Stage III: • In lymph nodes above and below the diaphragm. • In one part of a tissue or an organ near these lymph node groups • It may also be found in the spleen • Stage IV: • In several parts of one or more organs or tissues • In an organ and in distant lymph nodes

  20. Lymphoma #36 Enlarged Spleen

  21. Lymphoma in a 16-year-old girl with a 3-week history of supraclavicular adenopathy PET Lymphoma #37

  22. Diagnostic Medical Sonography: Lymphoma #38

  23. Lymphoma manifesting as a large mass almost filled by a huge ulcer (arrows).About 5% to 10% of patients with lymphoma have involvement of the gastrointestinal tract, primarily of the stomach and small bowel. LYMPHOMA #39

  24. Skeletal – “ivory vertebrae”Skeletal involvement can be demonstrated in about 15% of patients with lymphoma #39

  25. Lymphatic obstruction Lymphedema • Symptoms: • Chronic swelling, usually of the arm or leg • is the clinical hallmark of lymphatic obstruction.

  26. LYMPHANGIOGRAM Procedure #28 • The test is not often done now in the diagnosis or staging of lymphoma.  • The test is performed by injecting a dye & contrast agent into the lymphatic vessels of the foot

  27. Lymphangiogram #29 • CT and U/S have been used to successfully stage tumors – replacing lymphangiogram • 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. • Gallium Scan (NM). MRI or PET – CT & US still the best choice – CT is best for Hodgkins Although lymphography was the procedure of choice in the past, MRI and positron emission tomography (PET) are now the noninvasive techniques employed to demonstrate lymphomatous involvement of the abdominal and pelvic nodes. In practice, CT of the chest, abdomen, and pelvis is generally the first imaging procedure used in staging lymphoma, especially non-Hodgkin's lymphoma,

  28. Lymphography- Procedures • General term applied to the radiologic examination of: • Lymph nodes • Lymph Vessels • Usually done to demonstrate pelvis and abdomen • Injected in foot • For axillary, clavicular area and upper limbs • Injected in hand • Checks drainage of lymph nodes • Checks for pathology

  29. Pre Procedure • Obtain PT history • Obtain PT consent • Make sure to have all supplies • Positioning aides and comfort supplies

  30. The technologist has many responsibilities during this exam.

  31. Procedure Patient prep • Empty bladder • long procedure (4-5 hours) over 2 days • Special attention to patient’s physiological needs (Ca pt)

  32. The technologist must: • Get a good patient history • LMP • Any bleeding problems • Any previous allergic reactions to contrast media • Explain the procedure and any instructions for after the exam • Get the consent form signed

  33. Once the patient is on the table the injection site will be cleaned • Next, a special blue dye (patent blue violet) is injected. • Methaline Blue • injected into the subcutaneous web spaces of the hand or foot about 15 min. before the test begins.

  34. Procedure • Inject blue dye under skin in between toes • Inject small amount of contrast into the lymph vessels • Show blue tint • Nodes in pelvis and abdomen are demonstrated with foot injection

  35. Affects of the blue dye on the patient: • The skin, stool, and urine will have a blue tint. • The lymph vessels look like thin, blue lines. • Vision can even take on a bluish tint. • The affects of the dye can last from a few hours to 48 hours.

  36. After the 15 minutes are up, the local anesthetic is injected.Then a longitudinal incision is made in one of the lymph vessels shown with the dye.

  37. Procedure • Small cut-down made on top of foot • Slow injection of 5 – 10 ml/extremity @ 1.25 hr • Room – radiographic (usually does not need fluoroscopic

  38. A needle/catheter is then placed in the vessel and the contrast is injected in.

  39. Fluoroscopy is used to see if the contrast is in the correct vessel. • The progress of the contrast will be recorded under fluoro.

  40. Procedure • X-rays are usually taken 1 HR after injection • 24 hrs • 48 hrs (if needed) • 72hrs (if needed) • First hour • Contrast in lymph ducts • 24 hours • If lymph nodes • After 24 hours it is indicative of cancer

  41. Once the contrast has been injected, the incision is sutured, and regular radiographic images are taken within the hour. • A second setof x-rays are taken for the lymph nodes 24 hours later.

  42. 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 A fluoroscopy room will be used for the exam.

  43. When the feet are injected the lymphatics in these areas are seen: • Lower extremity • Abdominal area • Groin • Thoracic duct

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