Neurologic Complications Following Lymphangiography

Jay, James C.; Ludington, Louis G.

doi:10.1001/archsurg.1973.01350180095027

Cited by 4 publications

(3 citation statements)

References 12 publications

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“…No death occurred. Sclerosant 51 (4) 5% ethanolamine oleate 3 Sclerosant 46 (3) Bleomycin 4 Sclerosant 32 (2) Polyvinyl alcoholparticles 5 Embolic 16 (1) Stainless steel, movable-core guidewires 6 Embolic 3 (<1) Recombinant thrombin 7 Embolic 3 (<1) Amplatzer vascular plug 8 Embolic 1 (<1) OK-432 9 Sclerosant 1 (<1) Onyx 10 Embolic 1 (<1) Gelatin sponge slurry 11 Embolic 1 (<1) The migration of embolic agents, primarily involving glue, into normal veins or pulmonary arteries occurred in 13 (52%) procedures (9 type A, 2 type B, 1 type C, and 1 type D complication). Skin injury and ulceration occurred in 6 (24%) procedures (1 type A and 5 type B complications).…”

Section: Complicationsmentioning

confidence: 99%

“…At 20 • C, the viscosity of Lipiodol ranges between 34 and 70 cP and has a density of 1.28 g/mL 17, compared to 1.0 cP and 1.0 g/mL for water, respectively [3]. Due to its high viscosity and dense radiopacity, approved indications for the use of EPO include lymphangiography, hysterosalpingography, and intra-arterial imaging/treatment of hepatocellular carcinoma [4][5][6]. EPO is considered a standard treatment for unexplained and endometriosis-related infertility [7,8], but the dosage of EPO should be as low as possible to minimize the risk of fetal or neonatal thyroid dysfunction [9].…”

Section: Introductionmentioning

confidence: 99%

“…The use of injectable EPO is generally safe. Nevertheless, several complications have been reported, including pulmonary embolism, transient fever, lymphangitis, transient hypothyroidism, allergic reaction, local inflammation, foreign body reactions, and paradoxical emboli causing stroke [4][5][6][14][15][16][17][18]. Due to its high viscosity, EPO can cause temporary occlusion of the vessel and ischemia, particularly the pulmonary artery or systemic arteries, in the presence of right-to-left shunts [19].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Uses and Short-Term Safety Profile of Ethiodized Poppy Seed Oil Contrast Agent in the Diagnosis and Treatment of Vascular Anomalies and Tumors

et al. 2021

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Background: There is a sparsity of data on the use of ethiodized poppy seed oil (EPO) contrast agent (Lipiodol) in patients. We investigated the safety of EPO in children, adolescents, and some adults for diagnostic and therapeutic interventions. Methods: All patients who underwent procedures with EPO between 1995 and 2014 were retrospectively included. Demographic characteristics, diagnosis, dose, route of administration, preparation of EPO in combination with other agents, and complications were recorded. Results: In 1422 procedures, EPO was used for diagnostic or treatment purposes performed in 683 patients. The mean patient age was 13.4 years (range: 2 months–50 years); 58% of patients were female. Venous malformations (n = 402, 58.9%) and arteriovenous malformations (n = 60, 8.8%) were the most common diagnosis. Combined vascular anomalies included capillary–lymphatic–venous malformations, fibroadipose vascular anomalies (n = 54, 7.9%), central conducting lymphatic anomalies (n = 31, 4.5%), lymphatic malformations (n = 24, 3.5%), aneurysmal bone cysts (n = 22, 3.2%), and vascularized tumors (n = 11, 1.6%). In 1384 procedures (96%), EPO was used in various combinations with sclerosing and embolization agents, including sodium tetradecyl sulfate, ethanol, and glue. The mean volume of EPO used in interventions was 3.85 mL (range: 0.1–25 mL) per procedure with a mean patient weight of 45.9 kg (range: 3.7–122.6 kg) and a weight-adjusted dose of 0.12 mL/kg (range: 0.001–1.73 mL/kg). In 56 procedures (4%), EPO was used as a single agent for diagnostic lymphangiography. The mean volume was 4.8 mL (range: 0.3–13 mL) per procedure with a mean patient weight of 27.4 kg (range: 2.4–79.3 kg) and a weight-adjusted dose of 0.2 mL/kg (range: 0.04–0.54 mL/kg). Procedural-related complications occurred in 25 (1.8%) procedures. The 20 minor and 5 major complications were related to the primary treatment agents. None of them were directly related to EPO. No allergic reactions were noted. Conclusion: The use of an ethiodized poppy seed oil contrast agent in children, adolescents, and adults for diagnostic or therapeutic purposes is safe.

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Section: Complicationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical Uses and Short-Term Safety Profile of Ethiodized Poppy Seed Oil Contrast Agent in the Diagnosis and Treatment of Vascular Anomalies and Tumors

et al. 2021

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Postlymphographic cerebral lipid embolization in the vena cava superior syndrome

Andersen

Fogelberg

Rosencrantz

et al. 1977

Cancer

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A recent case of Lipiodol UltrafluidR embolism to the brain is reported. Pathogenetic concepts involving right-to-left shunts, and lympho-venous shunts with pulmonary capillary overloading a r e reviewed. Ili addition, it is suggested that a local disturbance in cerebral circulation d u e to a cava superior syndrome may contribute to the severe cerebral symptoms. The purpose of this report is t o add a recent case t o t h e previously reported, t o briefly review t h e literature, a n d to discuss predisposing factors. CASE REPORTR.S., a 37-year-old seaman, was admitted in September 1974 because of swollen lymph nodes in the neck. In 1965 he had undergone a thoracotomy because of a vena cava superior syndrome thought to have a traumatic origin. A fibrotic-constricted part of the vein was replaced by a teflon prosthesis, but was later obliterated by thrombosis. An extensive network of anastomotic veins developed on the upper arms, thorax and abdomen, and his facial congestion and dyspnoea diminished. Still, his respiratory function was somewhat restricted, perhaps due to postoperative adherences. In addition, he had alcohol problems. In 1972 he had an episode of delirium tremens in the tropics, and durihg 1973 he suffered some minor head injuries. During periods of alcohol abstinence he had a few epileptic fits.At admission, large lymph nodes were found on both sides of the neck, but not in other areas. A subcutaneous network of venous anastomoses was seen on the thorax, shoulders and upper abdomen. A few hours after the investigation the patient was found lying with his eyes open but unable to follow his surroundings, and unresponsive apart from answering "yes." He was incontinent and febrile (39.2O C). A neurological examination disclosed a sucking reflex, slightly dilated pupils with a sluggish reaction to light, a left gaze paralysis and a nystagmus elicited by right gaze. The optic fundi were normal without signs of embolization. The upper extremities were paralytic. Tendon reflexes were normal in the arms, brisk in the lower extremities. A Babinski sign was found bilaterally. The CSF composition was normal but the lumbar pressure was possibly elevated, 22 cm H20. There were no signs of pulmonary embolism. The arterial blood gases were normal. The following day the chest x-ray was normal. The middle portion of the thoracic duct was still filled with contrast medium (Fig. 1). A film of the abdomen showed, besides the remaining contrast in lumbar and iliac lymph nodes, a remarkably good delineation of the contours of the kidneys. In retrospect this was also demonstrable in the films taken a few hours after the Lipiodol UltrafluidR injection (Fig. 2). We believe that it was due to an accumulation of contrast medium in the cortex of the kidneys. No chylomicrons were demonstrated in the urine. A lateral view of the skull disclosed no visible contrast deposits. Repeated examinations of coagulation factors and platelets did not show any signs of disseminated intravascular coagulation. A diagnosis of cerebral contra...

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A comprehensive review of the natural lymphaticovenous communications and their role in lymphedema surgery

et al. 2016

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Cancer-related lymphedema is a progressive, chronic condition that impairs quality of life. Its pathophysiology and the mechanisms of action of current reconstructive surgical treatments are not fully understood but lymphaticovenous communications may play a key role. We review the available literature on lymphaticovenous communications and their implications in lymphedema surgery, and propose a subclassification of lymphaticovenous communications. J. Surg. Oncol. 2016;113:374-380. © 2016 Wiley Periodicals, Inc.

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Neurologic Complications Following Lymphangiography

Cited by 4 publications

References 12 publications

Clinical Uses and Short-Term Safety Profile of Ethiodized Poppy Seed Oil Contrast Agent in the Diagnosis and Treatment of Vascular Anomalies and Tumors

Clinical Uses and Short-Term Safety Profile of Ethiodized Poppy Seed Oil Contrast Agent in the Diagnosis and Treatment of Vascular Anomalies and Tumors

Postlymphographic cerebral lipid embolization in the vena cava superior syndrome

A comprehensive review of the natural lymphaticovenous communications and their role in lymphedema surgery

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