Korean J Radiol.  2020 Mar;21(3):298-305. 10.3348/kjr.2019.0313.

A Canine Model for Lymphangiography and Thoracic Duct Access

• Kim KY
• Park JH
• Tsauo J
• Shin JH

• KMID: 2470753
• DOI: http://doi.org/10.3348/kjr.2019.0313

Abstract

OBJECTIVE
To evaluate the technical feasibility of intranodal lymphangiography and thoracic duct (TD) access in a canine model.
MATERIALS AND METHODS
Five male mongrel dogs were studied. The dog was placed in the supine position, and the most prominent lymph node in the groin was accessed using a 26-gauge spinal needle under ultrasonography (US) guidance. If the cisterna chyli (CC) was not opacified by bilateral lymphangiography, the medial iliac lymph nodes were directly punctured and Lipiodol was injected. After opacification, the CC was directly punctured with a 22-gauge needle. A 0.018-in microguidewire was advanced through the CC and TD. A 4-Fr introducer and dilator were then advanced over the wire. The microguidewire was changed to a 0.035-in guidewire, and this was advanced into the left subclavian vein through the terminal valve of the TD. Retrograde TD access was performed using a snare kit.
RESULTS
US-guided lymphangiography (including intranodal injection of Lipiodol [Guerbet]) was successful in all five dogs. However, in three of the five dogs (60%), the medial iliac lymph nodes were not fully opacified due to overt Lipiodol extravasation at the initial injection site. In these dogs, contralateral superficial inguinal intranodal injection was performed. However, two of these three dogs subsequently underwent direct medial iliac lymph node puncture under fluoroscopy guidance to deliver additional Lipiodol into the lymphatic system. Transabdominal CC puncture and cannulation with a 4-Fr introducer was successful in all five dogs. Transvenous retrograde catheterization of the TD (performed using a snare kit) was also successful in all five dogs.
CONCLUSION
A canine model may be appropriate for intranodal lymphangiography and TD access. Most lymphatic intervention techniques can be performed in a canine using the same instruments that are employed in a clinical setting.

Keyword

Lymphangiography; Lymphatic intervention; Canine; Thoracic duct; Cisterna chyli

MeSH Terms

Animals
Catheterization
Catheters
Dogs
Ethiodized Oil
Fluoroscopy
Groin
Humans
Lymph Nodes
Lymphatic System
Lymphography*
Male
Needles
Punctures
SNARE Proteins
Subclavian Vein
Supine Position
Thoracic Duct*
Ultrasonography
Ethiodized Oil
SNARE Proteins

Figure

• 

  Fig. 1 Inguinal lymph node puncture. A. Ultrasound image shows needle tip (arrow) located in cortex of lymph node. B. Lymphangiography via intranodal injection of Lipiodol (Guerbet) shows tortuous lymphatic collectors connected to superficial inguinal lymph node. C. Lipiodol drains via pelvic retroperitoneal wall to right medial iliac lymph nodes (arrowheads). D. Contralateral access was re-tried due to overt extravasation at injection site on right-hand side. Lipiodol traversing left medial iliac lymph nodes to distal thoracic duct (arrows).

• 

  Fig. 2 Thoracic duct lymphangiography. A. Distal thoracic duct (arrowheads) and cisterna chyli (arrow) are visible. Either thoracic duct or cisterna chyli could be punctured. B. In another canine, lymphangiography shows that distal thoracic duct consists of two thin ducts (arrowheads). Cisterna chyli (arrow) is also visible.

• 

  Fig. 3 Transabdominal puncture of cisterna chyli. A. Anterior/posterior view shows seemingly successful transabdominal puncture of cisterna chyli. B. Lateral-oblique view shows that needle tip is penetrating cisterna chyli (arrow). C. Microguidewire and 4-Fr introducer catheter are advanced through cisterna chyli. D. Entire thoracic duct is visible by lymphangiography via 4-Fr introducer catheter.

• 

  Fig. 4 Retrograde thoracic duct access technique. A. 0.035-in guidewire is passed through terminal thoracic duct (arrow). B. 4-Fr goose neck snare kit is inserted through left subclavian vein, and is used to capture 0.035-in guidewire tip (arrow). C. 5-Fr catheter is advanced over guidewire (arrowheads). D. Final lymphangiography via retrograde access shows distal thoracic duct (arrowheads).

• 

  Fig. 5 Post-procedural CT images. A. Coronal reconstructed CT image shows pelvic retroperitoneal lymphatic tract (arrowheads) and intraabdominal portion of thoracic duct (arrows). B. Coronal reconstructed CT image shows intrathoracic portion of thoracic duct (arrowheads). C. Fluoroscopy image after lymphangiography shows multiple Lipiodol droplets distributed along both pulmonary arteries (arrowheads).

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