Intranodal lymphangiography

Intranodal lymphangiography (INL) is a minimally invasive procedure that allows your doctor to see real-time, moving images of your lymphatic system. Lymph fluid moves through a network of lymphatic vessels to hundreds of lymph nodes in your body. These organs act as a filter to manage your fluid levels and support your immune system. But damage to lymphatic vessels can cause leaks or blockages. INL helps your doctor pinpoint exactly where the damage is located to plan your treatment.

Penn Medicine’s interventional radiologists and experts at the Center for Lymphatic Diseases and Lymphedema specialize in diagnosing complex lymphatic diseases using innovative technology like intranodal lymphangiography. We’re one of the few centers in the nation to focus solely on lymphatic diseases, which means we bring the highest level of expertise to your diagnosis and treatment. Our center also provides advanced imaging procedures not available at other centers, including INL. As world-leading specialists, we provide expert care that improves your quality of life.

Your doctor may recommend this procedure if you have swelling or other symptoms that point to a blockage or leak in your lymphatic system. This can happen due to surgery, radiation treatment, injury, or other causes. It can lead to the buildup of lymph fluid in your tissues, like in your arm or leg (lymphedema). The fluid can also leak into your chest cavity (chylothorax) or abdominal cavity (chylous ascites).

Your doctor uses intranodal lymphangiography to find the source of the fluid leak and check for blockages. This test differs from standard imaging procedures and magnetic resonance lymphangiography (MRL) in that it creates more detailed images of your lymphatic vessels.

Your health care team will let you know how to prepare for the procedure, including whether you should stop taking certain medications and when to stop eating and drinking. On the day of your test, you’ll receive anesthesia to help you feel comfortable, and you may be given mild sedation to relax you. Your interventional radiologist uses ultrasound to precisely guide a needle to a lymph node in your groin and inject an oil-based contrast dye. This allows your lymphatic vessels and the flow of lymph fluid to be seen on live x-rays (fluoroscopy). Your doctor uses the images to create a detailed map of your lymphatic system, called a lymphangiogram.

After the procedure, you’ll rest in a recovery room as your sedation wears off. A bandage will cover the injection site. Your health care team will give you instructions on when you can return to your usual routine. They’ll also schedule a follow-up visit with your doctor to go over your results. You’ll go home the same day.

Penn Medicine is one of the largest interventional radiology programs in the country, providing minimally invasive options for lymphatic disease care that use small incisions to help speed recovery. We also have more than 25 years of experience in lymphatic disorders. As a recognized Lymphatic Education & Research Network (LE&RN) Comprehensive Center of Excellence, we meet high standards to help you manage your lymphatic disease.