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Review
. 2022 Sep;35(6):701-710.
doi: 10.1002/ca.23867. Epub 2022 Apr 9.

The lymphatic system throughout history: From hieroglyphic translations to state of the art radiological techniques

Caroline J van Schaik  1 , Lucas L Boer  2 , Jos M T Draaisma  3 , Carine J M van der Vleuten  4 , Jan Jaap Janssen  1 , Jurgen J Fütterer  1 , Leo J Schultze Kool  1 , Willemijn M Klein  1
Affiliations
Review

The lymphatic system throughout history: From hieroglyphic translations to state of the art radiological techniques

Caroline J van Schaik et al. Clin Anat. 2022 Sep.

Abstract

A comprehensive lymphatic system is indispensable for a well-functioning body; it is integral to the immune system and is also interrelated with the digestive system and fluid homeostasis. The main difficulty in examining the lymphatic system is its fine-meshed structure. This remains a challenge, leaving patients with uninterpreted symptoms and a dearth of potential therapies. We review the history of the lymphatic system up to the present with the aim of improving current knowledge. Several findings described throughout history have made fundamental contributions to elucidating the lymphatic system. The first contributions were made by the ancient Egyptians and the ancient Greeks. Vesalius obtained new insights by dissecting corpses. Thereafter, Ruysch (1638-1731) gained an understanding of lymphatic flow. In 1784, Mascagni published his illustration of the whole lymphatic network. The introduction of radiological lymphography revolutionized knowledge of the lymphatic system. Pedal lymphangiography was first described by Monteiro (1931) and Kinmonth (1952). Lymphoscintigraphy (nuclear medicine), magnetic resonance imaging, and near-infrared fluorescence lymphography further improved visualization of the lymphatic system. The innovative dynamic contrast-enhanced magnetic resonance lymphangiography (DCMRL) transformed understanding of the central lymphatic system, enabling central lymphatic flow disorders in patients to be diagnosed and even allowing for therapeutic planning. From the perspective of the history of lymph visualization, DCMRL has ample potential for identifying specific causes of debilitating symptoms in patients with central lymphatic system abnormalities and even allows for therapeutic planning.

Keywords: dynamic MR lymphangiography; lymphatic system; lymphography; therapeutic embolization.

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Figures

FIGURE 1
FIGURE 1
Adriaen backer, anatomy lesson of Dr. Frederik Ruysch, 1670. Ruysch, demonstrating the inguinal lymph nodes, is surrounded by members of the Guild of Surgeons (Leendert Fruijt, Aert van Swieten, Gillis Hondekoeter, Rogier de Coen, Joris van Loon Tilanus, and Jacob Brandt). Courtesy of the Amsterdam Museum
FIGURE 2
FIGURE 2
Paolo Mascagni, Table XXIV (from Vasorum Lymphaticorum Corporis Humani Historia et Ichnographia, 1787. Courtesy of the health sciences library, University of Washington)
FIGURE 3
FIGURE 3
Pedal lymphography
FIGURE 4
FIGURE 4
Pedal lymphography
FIGURE 5
FIGURE 5
Dynamic contrast‐enhanced magnetic resonance lymphangiography demonstrating a normal central lymphatic system. Coronal maximum intensity projection (MIP) of T1‐weighted sequences post intranodal contrast shows the thoracic duct (arrow point) and cisterna chyli (arrow)
FIGURE 6
FIGURE 6
Dynamic contrast‐enhanced magnetic resonance lymphangiography demonstrating a central lymphatic flow disorder. Coronal maximum intensity projection (MIP) of T1‐weighted sequences post intranodal contrast shows leakage into pericardial fluid (arrow) from the thoracic duct (arrow point)
FIGURE 7
FIGURE 7
Normal lymphoscintigraphy of the lower limbs
FIGURE 8
FIGURE 8
Near‐infrared fluorescence with indocyanine green (ICG) of the distal upper limb demonstrating functional lymph vessels on the dorsal side of the hand (arrow) and diffuse dermal backflow proximal to the wrist (arrow point)
FIGURE 9
FIGURE 9
Lymphography, showing the thoracic duct (arrow), after occluding leakage points with Lipiodol® (ethyl esters of iodinated fatty acids of poppy seed oil; manufacturer: Guerbet, Villepinte, France) and through coils (arrow point)
FIGURE 10
FIGURE 10
Graphic display of the central lymphatic anatomy. Illustration rights owned by the Department of Medical Imaging, Radboudumc Nijmegen
See this image and copyright information in PMC

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