Visceral lymphography: an experimental study.

Abstract

During the past decade a vast amount of experience has accumulated in lymphography of the lymph channels and nodes arising in the extremities. This report is a radiologic study of the lymphatic structures originating from the abdominal viscera in dogs. To our knowledge it is the first systematic attempt at visceral lymphography in living animals, although occasional injections of radiopaque or radioactive materials have been made into visceral lymphatics to visualize a small segment (2, 3). The definitive anatomic description of the visceral lymphatic structures of the dog was given by Baum (1). Materials “Acute” experiments were performed in 26 apparently normal mongrel dogs. In 4 animals employed in “chronic” experiments, the side-effects of visceral lymphography were evaluated. Methods Under Pentothal anesthesia and endotracheal intubation, laparotomy was performed. To identify the lymphatics of the viscera, a small amount (0.2 cc) of 4 per cent Direct Sky Blue was injected, usually subserosally. In the bowel studies this injection was made in the antimesenteric side. Instantaneous staining of numerous lymph vessels occurred. Frequently, the physiologically present white chyle permitted identification of the lymphatic channels without injection of the blue dye. Cannulation was performed, using a 25- to 3D-gauge needle fitted to PE 50 tubing. Usually the lymphatic vessel was not stripped. The needle was secured by a single silk suture in the mesentery. The contrast media (Ethiodol, Thorotrast, etc.) were injected by an automatic injector— 1–4 cc over a period of twenty to sixty minutes. Serial radiographs of the abdomen were obtained in the anteroposterior and left posterior oblique projections to demonstrate the opacified lymphatic structures. In “acute” experiments, the dogs were sacrificed at the completion of the radiographic studies. In “chronic” experiments, the same methods were applied, but with sterile technic. After the injection was completed, close-up photographs of the site of injection were obtained. The animals were observed clinically for two weeks and then re-operated upon. Follow-up photographs of the same area were obtained. The injected organ and the first-echelon lymph nodes were removed en bloc, and gross pathologic and histologic examinations were performed. Anatomy The anatomy of the visceral lymphatic structures of the dog is illustrated in diagrams on the anatomical studies of Baum (Figs. 1 and 2). The collectors from the liver, gallbladder, pancreas, stomach, and duodenum go to the right and left portal nodes, situated on either side of the portal vein. The efferent lymphatics from these nodes form the intestinal trunks. These join the lumbar trunks to form the cisterna chyli, from which the thoracic duct originates.