LAUSR

We present X-ray images of the course of lower limb lymphatics visualized by direct oil contrast lymphography. Contrast X-ray lymphography is an obsolete imaging method that provides detailed information about the course and localization of lymphatics. This is due to the nature of the contrast, which only flows though lymphatic tissues and where it temporarily accumulates, thus enabling a large area of lymphatic drainage to be imaged. A total of 48 direct oil contrast X-ray lymphographies were evaluated, which were performed on healthy women between 1975 and 1977. The images show that lymph from the lower limb passes primarily through all lymphatic basins that are important in the surgical staging of gynecological cancers: inguinofemoral, pelvic and para-aortic. Visualized lymphatics of the lower limb running from the ankle to the cisterna chyli can be divided according to the character of the lymphatic course into three parts: distal, which traversed the entire lower limb to the inguinal nodes (Fig. 1a); middle, the shortest part, between the inguinal and first pelvic nodes (Fig. 1b, c); and proximal, which ran through the pelvis and para-aortic region to the thoracic duct (Fig. 1d). The middle (shortest) part, passing through the abdominal wall, showed a different pattern of lymphatic drainage (Fig. 1b, c). There are fewer lymph nodes on both sides of this section, which are connected by a smaller number of collectors. These collectors do not run directly, but in an arcuate manner. The morphological difference in this medial part of the lower limb lymphatics may be the reason for the vulnerability of this area due to the development of lymphedema after surgery.