Introduction

Abstract

The first systematic investigations of the lymphatic system can be credited to Asellius in 1627 [3] and Pecquet in 1653 [33]. In 1787, Mascagni [26] presented a comprehensive essay on the human lymphatic system based upon the visualization of the lymphatics using mercury (Fig. 1). In more recent times, particularly the work of Bartels [4], Rouvière [42] and Haagensen [15] deserves mention. In 1932, Shdanov [45] was one of the first to succeed in visualizing parts of the lymphatic system roentgenologically, employing compounds of mercury, lead or silver. In 1952, it was Kinmonth [19] who introduced the routine use of lymphography. In the following years the method steadily became more sophisticated, especially with the introduction of oily contrast media. The visualization of the lymphatic drainage system then began to attract great clinical interest because of its potential in the diagnosis and therapy of malignancies. The considerable time taken up by the examination and the occasional failures due to imperfect technique limit the usefulness of lymphography. Another disadvantage is the fact that with bipedal lymphography only the inguinal, iliac and retroperitoneal lymph nodes up to the cisterna chyli can be demonstrated, as from the cisterna chyli the lymph flows into the thoracic duct without passing through any more lymph nodes. There were many attempts to depict lymph nodes in other regions by lymphography. By injecting oily contrast media into a retroauricular lymph vessel it is possible to visualize groups of cervical lymph nodes, but this diagnostic method is difficult and failed to become popular. The same applies to lymphography of the upper limb and to direct lymphography of the female breast [18].