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ABDOMINAL LYMPHOGRAPHY: A STUDY WITH SPECIAL REFERENCE TO THE INDIVIDUAL VARIATIONS IN DOSAGE OF CONTRAST MEDIUM

RAGNAR BJØRN-HANSEN and STEINAR HAGEN

An ideal lymphogram is obtained when the retroperitoneal lymph nodes are satisfactorily filled up to the level of the chylous cistern, and when the contrast material volume escaping to the lungs is kept at a minimum.

The needed amount of contrast medium showed great variation in our series of 100 patients. Three patients aged below 15 years needed very small amounts. This was also the case in a patient who had previously received chemotherapy for several years. In the remaining 96 patients the dose varied from 9.5 ml. to 28 ml. In these, the contrast medium volume did not show any relation either to the age or height of the patients. In cases with widespread infiltration of the retroperitoneal lymph nodes, the average dose of contrast medium needed was found to be slightly larger than in patients with normal or moderately abnormal lymphograms.

Widespread infiltration of the lymph nodes in a way seemed to protect the lungs from oil embolism. This is probably due to a greater storing capacity of the lymph nodes of the contrast material still in the lymphatics when the injection is stopped.

Temperature reaction of some duration was unusual in our material. Five patients, who had their thoracic ducts cannulated and where no oil was seen in the lungs, did not show any temperature reaction. Another patient also drained, but nevertheless with visible oil in the lungs, had fever reaction. This could suggest that the pyrexia may have some relation to the oil trapped in the lungs.

Considering the great variation in the different patients, it seems impossible to predict the desired dose of contrast medium. The only way to obtain a correct estimate is by following the contrast column with fluoroscopy at intervals, preferably by the use of an image intensifier. The injection should be stopped as soon as contrast material is seen in the thoracic duct; then the pulmonary changes caused by emboli will usually be moderate, and in our material we did not observe any serious pulmonary complications.


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