Interventional Radiology – MR Lymphangiogram

Presented by Maxim Itkin, MD, Director, HUP/CHOP Center for Lymphatic Imaging and Interventions

Abstract: Lymphatic malformations (LM) are conditions that are characterized by proliferation of the lymphatic tissue in multiple organs. The major cause of mortality and morbidity in patients with LM is deterioration of pulmonary function due to chronic chylous effusions and progressive interstitial lung disease. The etiology of these pulmonary processes is unknown, although lymphatic involvement is certain.

Understanding of the changes in the lymphatic anatomy in patients with LM has been hindered by difficulty of imaging of the lymphatic system. Recently developed Dynamic Contrast Enhanced MR Lymphangiography (DCMRL) allows dynamic MR imaging of the lymphatic system by injecting contrast agent in the groin lymph nodes. Using this technique, pathological lymphatic flow from the central lymphatic system and/or retroperitoneal and mediastinal masses into lung parenchyma (“Pulmonary Lymphatic Perfusion Syndrome”) has been demonstrated in patients with LM. This abnormal lymphatic perfusion overflows pulmonary parenchyma and results in deterioration of pulmonary function due to interstitial process and/or compression effect of chylous effusions.

Percutaneous closure of the thoracic duct results in cessation of the pulmonary lymphatic overflow and can significantly improve and prevent deterioration of pulmonary symptoms in LM patients.

Dr. Itkin

About the Presenter

Maxim Itkin, MD

Director, Center for Lymphatic Imaging and Interventions Program

Associate Professor of Radiology at the Hospital of the University of Pennsylvania

Associate Professor of Pediatrics

Dr. Itkin is an attending interventional radiologist with the Department of Radiology at the Hospital of the University of Pennsylvania. He is also a member of the Lymphatic Imaging and Intervention Program, a joint program of The Children’s Hospital of Philadelphia and Penn Medicine that provides highly specialized care for children and adults with lymphatic leaks and lymphatic flow disorders.

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