Lymphangiography in bancroftian filariasis

Abstract

1) A safe and effective method of lymphangiography is described in detail.2) Utilizing a fat-soluble contrast medium this technique permits opacification of lymph nodes as well as peripheral lymphatics.3) In the present study patients with filarial lymphoedema, scrotal oedema, inguinal adenopathy and chyluria were investigated.4) The abnormal peripheral lymphatic pattern of “dermal backflow,” previously noted with water-soluble contrast media, is confirmed. The radiographic abnormalities of involved inguinal lymph nodes include increase in number and size, filling defects and the development of tortuous afferent and minute efferent lymph vessels. The relationship between peripheral lymphatics and lymph nodes in the pathogenesis of filarial lymphoedema is discussed.5) An abnormal lymphangiographic pattern in patients with filarial chyluria is demonstrated. These abnormalities include diffuse, sacculated, collateral lymphatic channels by-passing iliac and para-aortic nodes. A concentrated plexus of dilated lymphatics is noted adjacent to the renal pelvis. In conflict with earlier theories localizing the site of obstruction to the thoracic duct, radiological patency was observed in two of three cases investigated. In addition to this direct demonstration of lymphatic pathology, biochemical, pyelographic and cystoscopic evidence of renal-lymphatic communication is presented.