Lymphadenography in Normal Subjects

Abstract

Lymphangiography, as a diagnostic method, has been used for many years on a limited scale for the evaluation of lymphatic channels in lymphedema and related diseases (6–13). Its adaptation to the visualization of lymph node architecture (lymphadenography) has been relatively recent (1, 3–5), with the chief emphasis on its use in neoplastic disease (2, 14–16). While the value of the procedure in lymphoma and far-advanced metastatic neoplasms has been well documented by several authors (15–16), the demonstration of early or subclinical metastases would have greater potential. The reliability of the procedure in this respect has not been established, and there are those who have questioned its worth (15). In order to evaluate lymphadenography in early neoplastic involvement of lymph nodes, the authors felt that further information regarding the appearance of nodal architecture in normal individuals was necessary. To date, there is no published report of lymphadenography in normal persons.2 Our purpose is to report findings in such a group. Materials and Methods Lymphangiograms were obtained on 8 male and 8 female volunteers from state penal institutions. These subjects ranged in age from twenty to forty years, were in good health, and were accepted only after history, physical examination, and review of medical records gave no evidence of neoplasm or active inflammatory disease. The procedure was performed following the methods of Kinmonth (8–13) as modified by Sheehan et al. (15) and Wallace et al. (16). Direct injection of 10 c.c. of Ethiodol3 into the lymphatics of the dorsum of the foot was accomplished bilaterally. This opacifies the femoral, inguinal, external iliac, and para-aortic nodes to the level of the cisterna chyli. Frontal and lateral roentgenograms of the pelvis and abdomen were made immediately following injection, and again after an interval of twenty-four hours. Nodal architecture was best demonstrated on films obtained at twenty-four hours, at which time the nodes were well opacified, and overlying lymph vessels were free of contrast material in most instances. Results and Discussion Metastatic deposits in individual lymph nodes have been described as being characterized by irregular marginal filling defects. The nodes may be slightly enlarged or of normal size. In lymphoma, on the other hand, nodal enlargement has been reported to be a prominent feature, and the nodes show a mottled, foamy, or lacy pattern. In the normal subjects comprising this study, irregularities of nodal architecture simulating neoplastic disease were found. Conspicuous marginal filling defects were identified in one or more nodes in a majority of those examined. Very close inspection revealed smaller defects in virtually all of the series. In one normal subject, an enlarged mottled node similar to that described in lymphoma was observed. Figure 1 illustrates the appearance of nodes in 2 of the few subjects who did not have conspicuous filling defects.