Lymphangiogram

prabha

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Is lipidol injection considered an embolizing agent or here it is used only for lymph imaging?

Is my understanding correct with the below codes,

38790
78195

or do I need to use 37244?

IR EMBOLIZATION VASCULAR ARTERIAL

Under ultrasound guidance, bilateral inguinal
lymph nodes were accessed using a combination of 25-gauge and 22-gauge needles at the cortical medullary junction. Slow infusion of lipiodol was performed under fluoroscopy to opacify the inguinal lymphatic ducts and serial radiography was performed to
follow cephalad transit of lipiodol along the lymphatic chain. On table cone beam CT angiography with 3D reconstructions were then performed for further evaluation. Post-processing was performed by the attending physician on an independent workstation.
After identification of focal pooling/extravasation of the bilateral at the L4/L5 level adjacent to the previously placed surgical clips, attempts were made at percutaneous catheterization of the lymphatic channel using a 20-gauge Chiba needle under
fluoroscopy. This was unsuccessful however, as the location of the leak was much below the level of the cisterna chiylii. All needles were removed and sterile dressings were applied.

FINDINGS: Scout radiograph demonstrates small left pleural effusion. Surgical clips are present at the L4-L5 level. Ultrasound evaluation of the bilateral inguinal region demonstrates very small bilateral inguinal lymph nodes. The left inguinal lymph
node was successfully accessed at the cortical medullary junction and resulted and adequate superior transit of lipiodol into the abdominal pelvic lymphatic channels. The right inguinal lymph node was only partially cannulated and result in inadequate
cephalad transit of lipiodol along the lymphatic channels. A small leak was identified at the L4-L5 level between the previously placed surgical clips, much below the level of the cisterna chylii. Cone beam CT angiography confirms the location of small
leak at the L4-L5 level. There is small amount of intra-abdominal ascites and cone beam CT.

Lymphangiogram with identification of small leak at the L4-L5 level, below the level of the cisterna chylii, unable to be accessed via percutaneous approach for thoracic duct embolization. Due to small nature of the leak, patient may benefit from
lipiodol embolization.
 
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