LYMPHOGRAM BY HYSTEROSALPINGOGRAPHY (Review of one case) by T. B. L. JAISWAL,* M.D., D.M.R.E. and K. c. MATHUR,** M.D., D.M.R.E. Lymphogram is obtained either by in­ hypogastric lymph nod s on both sides (Fig. 1) No serious complication was noticed after the jecting the contrast media in the lympha­ procedure. tic vessel or into the lymph node, but the The patient was further investigated by lymphogram obtained by hysterosalpingo­ dilatation and currettage but histopathological graphy is unusual. We are presenting in report did not reveal the diagnosis. The patient this communication such type of the un­ was put on hormonal treatment for 3 months for usual case which was seen during the her infertility. study of hysterosalpingography. Discussion Case Report Lymphogram obtained by hysterosal­ S.R. 30 years female attended in J .K. Cancer pingography is very uncommon. Erbsloh Institute, Kanpur with complaint of infertility (1949) was the first to introduce the and watery discharge of one year duration utero-lymphatic intravasation. After that She was married 6 years back and her men­ strual cycles were of 3 days duration with many authors like, Bourg (1962) Fischer moderate flow of the blood. (1966), Hipona and Dikchek (1966) and On vaginal examination uterus was midway Sinha and Das (1969) reported such type and mobile and no abnormality was felt. She of cases. was called on the 6th or 7th day of the last menstrual period for hysterosalpingography. Anatomically the bilateral iliopelvic Hysterosalpingography was performed under lymph nodes are in three groups (a) ex­ strict aseptic condition. Prior to technique the ternal iliac, (b) hypogastric, (c) common patient was sedated by giving Inj. Calmpose 1 iliac. The hypogastric lymph nodes are amp. intramuscularly. Ten mi. of Diaginol not visualised by lymphography (Fischer viscous 40 % was used as contrast media. The et al, 1962). These lymph nodes receive patient was examined unde; fluroscopic exami­ nation which showed normal uterus with partial afferants from all pelvic viscera and then tubal block, i.e. thin streaks of contrast media pass to the common iliac lymph nodes. were seen on both side of the uterus. The in­ The external and common iliac lymph jection of the contrast media was stopped and skiagram of the pelvis in anterio-posterior view nodes are three more or less parallel was taken. It showed the external iliac and chains in relations to the external and common iliac vessels. (a) Lateral external •Lecturer in Radiology (Radiotherapy), J.K. iliac chain, follows the lateral border of Cancer Institute, Kanpur. the iliac arteries and continues as lateral ••Professor & Hea;d of the Radiology Depart­ common iliac lymph nodes group, (b) ment, B.R.D. Medical College, Go.rakhpu1·. middle external iliac chain is located on Accepted for publication on 22-10-75. 262 JOURNAL OF OBSTETRICS AND GYNAECOLOGY OF INDIA the medial side of the iliac artery, while block of the fallopian tubes. A detailed the (c) medial chain is located on the study is required both in normal as well lateral pelvic wall inferior to the iliac as in pathological condition to further veins. The middle group of the common assess its diagnostic significance during iliac nodes occupies the angle formed by hysterosalpingography. the union of both common iliac arteries. The medial group is also visualised by Summa1·y lymphographic method. A case of lymphogram followed by In this case few hypogastric and medial hysterosalpingography is reviewed. This group of the external iliac lymph nodes is a very uncommon condition in which were visualised. According to Kika such type of the finding was seen in a (1954) the uterine lymphatics were seen normal subject. This has been discussed in tub.erculous salpingitis and this was with the other reported cases. also supported by Sinha (1969) but our References case did not show any clinical evidence of tuberculosis. By this the lymphatic 1. Bourg, R.: Gynec. & Obst. 61: 172, 1962. 2. Erabsloh, J.: Roentgenstrahelem. 80: 633, vessels were not seen. This may be either 1949. due to normal pelvic viscera or due to 3. Fischer, H. W., Lawrence, ·M. S. and delayed exposure of the pelvic skiogram. Thornbury, J. R.: Radial. 78: 399, 1962:. Visualisation of the lymph nodes and 4. Fischer, M. S. : Am. J. Roentg. 98: 233, lymphatics may have resulted due to in­ 1966. 5. Hipona, F. A., Ditchek, T.: Am. J. creased intrauterine pressure (Sinha Roentg. 98: 236, 1966. 1969), but in our case the intrauterine 6. Sinha, J. P. and Das, S . N.: Ind. J. of pressure was very low due to partial Radial. 23: 1, 28, 1969. See Fig. on Art Puper XV .