CardioVascular and Interventional Radiology

, Volume 35, Issue 6, pp 1488–1491 | Cite as

Transnodal Lymphangiography in the Diagnosis and Treatment of Genital Lymphedema

  • F. M. GómezEmail author
  • J. Martínez-Rodrigo
  • L. Martí-Bonmatí
  • E. Santos
  • I. Forner
  • M. Lloret
  • D. Pérez-Enguix
  • R. García-Marcos
Technical Note



To report the success of groin nodal lymphography in the diagnosis and treatment of genital lymphedema.

Methods and Materials

We present one female (8 years old [patient no. 1]) and two male (69 and [patient no. 2] 31 years old [patient no. 3], respectively) patients with genital lymphedema in whom conservative treatment failed. The girl also had lymphorrhagia. Genital lymphedema was caused by radical cystectomy (patient no. 2), lymphatic hyperplasia (patient no. 1), and idiopathic lymphangitis (patient no. 3). All of them underwent ultrasound-guided bilateral groin lymph node puncture. Afterward, 4–8 ml Lipiodol Ultra-Fluide (Guerbet) were injected at a rate of 0.2 ml/s. Lipiodol progression was assessed by fluoroscopy. Computed tomography scan of the abdomen and pelvis was performed immediately after and again at 24 h after the procedure to confirm the leak. The follow-up period was 15, 13, and 9 months, respectively. Technical success was considered as bilateral pelvic and abdominal filling of lymphatic vessels. Therapeutic success was considered as improvement or disappearance of genital lymphedema and/or lymphorrhagia.


Lipiodol leak to the scrotum was observed in patients no. 2 and 3. Lymphaticopelvic fistula and genital lymphatic hyperplasia were seen in patient no. 1. Genital lymphedema diminished within 1 week and almost disappeared in two cases (patients no. 1 and 3) or significantly improved (patient no. 2). lymphorrhagia also resolved in patient no. 1. No recurrence or worsening was detected during follow-up.


Therapeutic lymphangiography by lymph node injection seems to be effective to treat genital lymphedema. Lymph node puncture lymphangiography is feasible and less cumbersome than pedal lymphangiography.


Diagnostic Sub-specialty/technique Non-vascular interventions Specialty Urogenital Organ 


Conflict of interest



  1. 1.
    Alejandre-Lafont E, Krompiec C, Rau WS, Krombach GA (2011) Effectiveness of therapeutic lymphography on lymphatic leakage. Acta Radiol 52(3):305–311PubMedCrossRefGoogle Scholar
  2. 2.
    Rajebi MR, Chaudry G, Padua HM, Dillon B, Yilmaz S, Arnold RW et al (2011) Intranodal lymphangiography: feasibility and preliminary experience in children. J Vasc Interv Radiol 22(9):1300–1305PubMedCrossRefGoogle Scholar
  3. 3.
    Kos S, Haueisen H, Lachmund U, Roeren T (2007) Lymphangiography: forgotten tool or rising star in the diagnosis and therapy of postoperative lymphatic vessel leakage. Cardiovasc Interv Radiol 30(5):968–973CrossRefGoogle Scholar
  4. 4.
    Itkin M, Krishnamurthy G, Naim MY, Bird GL, Keller MS (2011) Percutaneous thoracic duct embolization as a treatment for intrathoracic chyle leaks in infants. Pediatrics 128(1):e237–e241PubMedCrossRefGoogle Scholar
  5. 5.
    Itkin M, Kucharczuk JC, Kwak A, Trerotola SO, Kaiser LR (2010) Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients. J Thorac Cardiovasc Surg 139(3):584–589 (discussion 589–590)PubMedCrossRefGoogle Scholar
  6. 6.
    Guermazi A, Brice P, Hennequin C, Sarfati E (2003) Lymphography: an old technique retains its usefulness. Radiographics 23(6):1541–1558PubMedCrossRefGoogle Scholar
  7. 7.
    Lu Q, Bui D, Liu NF, Xu JR, Zhao XH, Zhang XF (2012) Magnetic resonance lymphography at 3T: a promising noninvasive approach to characterise inguinal lymphatic vessel leakage. Eur J Vasc Endovasc Surg 43(1):106–111PubMedCrossRefGoogle Scholar
  8. 8.
    Pan WR, Rozen WM, Stretch J, Thierry B, Ashton MW, Corlett RJ (2008) Advanced imaging technologies for mapping cadaveric lymphatic anatomy: magnetic resonance and computed tomography lymphangiography. Lymphology 41(3):126–130PubMedGoogle Scholar
  9. 9.
    Deso S, Kabutey NK, Vilvendhan R, Kim D, Guermazi A (2010) Lymphangiography in the diagnosis, localization, and treatment of a lymphaticopelvic fistula causing chyluria: a case report. Vasc Endovasc Surg 44(8):710–713CrossRefGoogle Scholar
  10. 10.
    Mukenge SM, Catena M, Negrini D, Ratti F, Moriondo A, Briganti A et al (2011) Assessment and follow-up of patency after lymphovenous microsurgery for treatment of secondary lymphedema in external male genital organs. Eur Urol 60(5):1114–1119PubMedCrossRefGoogle Scholar
  11. 11.
    Yamagami T, Masunami T, Kato T et al (2005) Spontaneous healing of chyle leakage after lymphangiography. Br J Radiol 78(933):854–857PubMedCrossRefGoogle Scholar
  12. 12.
    Oremus M, Dayes I, Walker K, Raina P (2012) Systematic review: conservative treatments for secondary lymphedema. BMC Cancer 12(1):6PubMedCrossRefGoogle Scholar
  13. 13.
    Luchtenberg M, Mikowski A, Schalnus R et al (2000) Erythematous eyelid swelling after dacryocystography. Perforation of the efferent lacrimal ducts in dacryocystography with contrast medium extravasation. Ophthalmologe 97(12):894–895PubMedCrossRefGoogle Scholar
  14. 14.
    O’Brien BM, Das SK, Franklin JD, Morrison WA (1981) Effect of lymphangiography on lymphedema. Plast Reconstr Surg 68(6):922–926PubMedCrossRefGoogle Scholar
  15. 15.
    Syed LH, Georgiades CS, Hart VL (2007) Lymphangiography: a case study. Semin Interv Radiol 24(1):106–110CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2012

Authors and Affiliations

  • F. M. Gómez
    • 1
    Email author
  • J. Martínez-Rodrigo
    • 1
  • L. Martí-Bonmatí
    • 1
    • 2
  • E. Santos
    • 3
  • I. Forner
    • 4
  • M. Lloret
    • 1
  • D. Pérez-Enguix
    • 1
  • R. García-Marcos
    • 1
  1. 1.Servicio de RadiologíaHospital Universitario y Politécnico La FeValenciaSpain
  2. 2.Departamento de MedicinaUniversidad de ValenciaValenciaSpain
  3. 3.Department of RadiologyUniversity of PittsburghPittsburghUSA
  4. 4.Servicio de Medicina Física y RehabilitaciónHospital Universitario y Politécnico La FeValenciaSpain

Personalised recommendations