Feature
Collaborative science fiction
Opportunities in lymphatic intervention By Maxim Itkin, MD, FSIR
T
he lymphatic system is comprised of a series of vessels that collect all the interstitial fluid throughout the body and
carry it through the thoracic duct into veins. Because the lymphatic system is solely responsible for removal of the proteins and interstitial fluid from the tissues, it is an active participant in any disorder that is associated with tissue congestion and edema. The lymphatic system consists of several organ subsystems (soft tissue, liver, intestine, kidney, etc.), each with a slightly different mechanism of lymph production and constitution of the lymph. Anatomy and communication between different subsystems is very complex and variable, and the lymphatic imaging techniques of lymphatic flow disorders for each system are unique.
24 IRQ | SUMMER 2020
This complicated anatomy has made the lymphatic system historically difficult to image and has resulted in a lack of interventional options.
This complicated anatomy has made the lymphatic system historically difficult to image and has resulted in a lack of interventional options. Despite its importance, these challenges have largely pushed the lymphatic system off the radar of modern medicine.
Recent development of several lymphatic imaging techniques (such
as intranodal lymphangiography, dynamic contrast-enhanced MR lymphangiography and liver lymphangiography) resulted in discovery of the pathological mechanisms of a variety of disease processes. Percutaneous lymphatic interventions over the decade expanded from one procedure— thoracic duct catheterization and embolization—to several that include interstitial lymphatic embolization, liver lymphatic embolization, thoracic duct stenting and externalization.
With IRs’ technical expertise, our imaging modalities and minimally invasive procedures, we are well positioned to map the lymphatic system, locate abnormalities and treat the root cause of a variety of symptoms.
Science fiction come to life During my last year of radiology residency at Rabin Medical Center in Israel, I read a paper by Constantin
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