DR. ABEER FAWZY EL SOBKYDR. ABEER FAWZY EL SOBKY

Master Degree In RadiodiagnosisMaster Degree In Radiodiagnosis

Lymphography

NephrostomyPlacing 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

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

TIPSPlacement 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

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.

Thank you