Interventional Management of Acquired Lymphatic Disorders

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 0.50
Procedures: 0.50
Neck and Chest: 0.25
Abdomen and Pelvis: 0.25

Magnetic Resonance Imaging: 0.50
Procedures: 0.50
Body: 0.50

Nuclear Medicine Technology: 0.25
Procedures: 0.25
Other Imaging Procedures: 0.25

Registered Radiologist Assistant: 2.25
Procedures: 2.25
Neurological, Vascular, and Lymphatic Sections: 2.25

Sonography: 0.25
Procedures: 0.25
Abdomen: 0.25

Radiation Therapy: 0.25
Procedures: 0.25
Treatment Sites and Tumors: 0.25

Vascular-Interventional Radiography: 2.25
Procedures: 2.25
Vascular Diagnostic Procedures: 2.25

Outline

1. Introduction

• Lymphatic System Anatomy and Physiologic Characteristics
  1. Conventional Anatomy
  2. Anatomic Variants of the TD
  3. Anatomic Variants: TD Insertion
• Lymphatic Disorders
  1. Chyle Leak
  2. Chylous Pleural Effusion
  3. Chylous Ascites
  4. Protein-Losing Enteropathy
• Noninvasive Management
  1. Lymphedema
  2. Chyle Leaks
• Diagnostic Lymphangiography
  1. MR Lymphangiography
  2. Transpedal Lymphangiography
  3. Intranodal Lymphangiography
• Interventional Management
  1. Peripheral Lymphatic Embolization
  2. Transabdominal Access and TD Embolization
  3. Retrograde Transvenous and Transcervical Accesses
  4. Mesenteric Lymphangiography
  5. TD Stent Placement
  6. Transhepatic Lymphangiography and Embolization
• Conclusion

Objectives

Upon completion of this course, students will:

1. identify the most common causes of chyle leakage
2. be familiar with the types of lymphatic disorders
3. be familiar with the imaging procedures for diagnosis and management of lymphorrhea
4. identify the main contributing compartments of the lymphatic system
5. be familiar with the anatomy of the cisterna chyli
6. be familiar with the physiology of the transthoracic duct
7. be familiar with the lymph of the liver and intestinal compartments
8. identify the anatomical variants of the TD
9. identify the most common anatomical variant of the TD
10. be familiar with the anatomic variant of the TD that leads to technical challenges
11. be familiar with the physiologic causes of lymphatic flow disorders
12. be familiar with the most common causes of chyle leaks
13. be familiar with common sequelae of chyle leaks
14. be familiar with the relationship of triglycerides and chylothorax
15. describe the condition of chylous ascites
16. identify the mechanisms for peritoneal accumulation of chyle
17. be familiar with the normal physiology of total body albumin leaked into the gastric lumen
18. identify the pharmacological agents that have shown benefits in the treatment of lymphatic flow disorders
19. identify the advantages of using MRL for lymphatic imaging
20. be familiar with the contrast media used for performing MRL
21. be familiar with the number of lymphatic pathways in the lower extremity
22. be familiar with the increased interest in performing intranodal lymphangiography
23. identify the gauge of Chiba needle use for percutaneous access of the CC
24. be familiar with the approaches to obtaining percutaneous retrograde access
25. be familiar with the use of US to facilitate puncture of the mesenteric lymph nodes
26. be familiar with the potential side effects of performing TD embolization
27. be familiar with the successful treatments that TD stent offers
28. be familiar with the connection between hepatic and duodenal lymphatics and PLE
29. identify the liquid embolics injected