Diagnostics and Visualization of The Lymphatic System in Clinical Practice

For decades, imaging of the lymphatic system was limited to lymphoscintigraphy and transvascular lymphangiography with X-ray. These methods do not provide information on the state of the central large lymphatic collectors and vessels. Obtaining images of the central link of the lymphatic pathways using radiographic examination has become possible due to the introduction of a contrast agent through a lymphatic vessel in the foot. The pronounced variant anatomy of the distal lymphatic bed and the technical difficulties in isolating such a vessel in a surgical wound make it difficult to perform these methods. Intranodal contrast injection combined with magnetic resonance imaging (MRI) has led to the development of dynamic contrast-enhanced MR lymphangiography, which provides exceptional imaging capabilities for the central lymphatic system. Due to the physical properties, primarily the viscosity of the oil-based contrast agent, visualization of the central lymphatic system may be inadequate without MRI. The issue of developing a reliable method for delivering the drug to the lymphatic system also remains relevant, which requires a surgical approach to the task. The role of lymphangiography as a diagnostic and therapeutic method has not yet been determined. A large number of patients with chylothorax and chyloperitoneum (up to 4% in thoracic interventions) of both iatrogenic and idiopathic etiology (up to 14%) make lymphangiography a promising method in treatment and diagnosis for the purpose of planning access and volume of surgery when conservative treatment is ineffective.