Little Leakers
Diagnosis and Tests
Here is some information on the tests noted above.


Upper GI endoscopy is usually performed on an outpatient basis.

The throat is often anesthetized by a spray or liquid. Intravenous
sedation is usually given to relax the patient, deaden the gag reflex
and cause short-term amnesia. For some individuals who can relax on their own and whose gagging can be controlled,
the exam is done without intravenous medications.

The endoscope is then gently inserted into the upper esophagus. The patient can breath easily throughout the exam.
Other instruments can be passed through the endoscope to perform additional procedures if necessary.
For example, a
biopsy can be done in which a small tissue specimen is obtained for microscopic analysis.

A polyp or tumor can be removed using a thin wire snare and electrocautery (electrical heat). The exam takes from 15 to
30 minutes, after which the patient is taken to the recovery area. There is no pain with the procedure and patients
seldom remember much about it.

The
Lymphoscintigraphy is done in a hospital nuclear medicine imaging department.

The radiotracer will be injected just beneath the skin, or sometimes deeper, using a very small needle.
Immediately after the injection, the gamma camera will take a series of images of the area of the body being studied.
When it is time for the imaging to begin, the gamma camera will take a series of images.

The type of study you are having will determine the location of your injection and the number of scans performed.
Leg or arm swelling (edema) — The radiotracer is injected between the first and second fingers or toes of each hand or
foot. Both the swollen and healthy arm or leg will be imaged so that the two sides can be compared. Depending on the
degree of lymphatic obstruction and the cause, imaging may take 30 minutes to several hours.

The
Lymphangiogram is done in a hospital radiology department or a health care provider's office.

If you are having the test done because of leg or arm swelling, you may be offered a sedative before the test to help you
relax. You sit in a special chair or on an x-ray table. The health care provider cleans your feet, and then injects a small
amount of blue dye into the webbing between your toes.

Thin, bluish lines appear on the top of the foot within 15 minutes. These lines identify the lymph channels. The health
care provider numbs the area, makes a small surgical cut into one of the larger blue lines, and inserts a thin flexible tube
into a lymph channel. This is done for each foot. Dye (contrast medium) flows through the tube very slowly, over a
period of 60 to 90 minutes.

A special x-ray machine, called a fluoroscope, projects the images on a TV monitor. The health care provider uses the
images to follow the dye as it spreads through the lymphatic system up your legs, groin, and along the back of the
abdominal cavity.

Once the dye is completely injected, the catheter is removed and stitches are used to close the surgical cut. The area is
bandaged. X-rays are taken of the legs, pelvis and abdomen.
So far the best way to confirm a diagnosis of Intestinal Lymphangiectasia is by small bowel biopsy.  This can be done by
an
upper GI endoscopy with biopsy.  

Endoscopic Findings:    Endoscopy will show white opaque spots on the small intestinal mucosa, which
                                    indicates dilated lacteal vessels.

Pathological Findings:    Findings at pathology include a dilatation of the lymphatics in the mucosa and
                                    submucosa of the small bowel with resultant bowel wall thickening due to edema
                                    and congestion.
Picture of a Upper GI Endoscopy
Results of a
Lymphoscintigraphy scan
There are other procedures that can help to check the
flow of the lymphatics.  Such as the
Lymphoscintigraphy scan.
(Lymphoscintigraphy: Imaging pathways of lymphatic flow
and lymph nodes after injection of a radiopharmaceutical
that is absorbed by the lymphatics.)
 This such test is
normally done in breast cancer patients or such.  I have
found that this procedure is not to be of considerable use
in IL patients.  Simply because IL is generally found
through out the small intestines and not generally in just
one location of the small intestine.  

The
Lymphangiogram is another test that can be used
to better check the lymphatic flow.
(The lymph nodes and
vessels are not usually seen on a normal x-ray, so a dye
or radioisotope (radioactive compound) is injected into
the body to highlight the area being studied.)
 This test is
generally done to check lymph flow in a limb or limbs.
For
example,
my son had this done on his lower body.  This
was to check the lymphatic in his legs to his hips.  His feet
and legs did not swell.  We found that his lymphatic
vessels were small and he was missing some receptors.  
Since then, the lymphatics have grown as he has grown.  
But they still remain small.