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It is difficult to perform lymphangiography on the edematous limbs of a patient with Kaposi sarcoma, but it has been done successfully. Because drainage from the Kaposi nodule is through both the veins and the lymphatics, there are large lymphatico-venous shunts. As a result, the lymphatics become dilated and clearance from them is slowed. Lymphatic back-flow distal to the skin tumors is common (Fig.42.21). Nodules that cannot be recognized clinically can be demonstrated by lymphangiography, and the thickened perivenous lymphatics may be accurately shown. Simultaneous filling of veins and lymphatics may be demonstrated. A unique finding on angiography is the demonstration of Kaposi nodules within enlarged lymph nodes: the tumors have obtained their own blood supply and fill by arteriography (see Fig. 42.7D).



Fig. 42.21 A-D. Lymphangiography in Kaposi sarcoma. (A) Multiple nodules, which were not suspected clinically, are filled by lymphangiography. There is marked thickening of the lymphatic trunks, especially those around the veins. (B) A large conglomerate Kaposi tumor is filled on lymphangiography. There is simultaneous drainage through both the lymphatics and the veins. There is backflow distal to the tumor. A small second nodule is filling proximally. Lymphangiography is difficult and seldom reveals information that materially affects the treatment of the individual. (C) A solitary Kaposi nodule in the upper forearm and (D) another nodule in a different patient above the elbow; both filled by lymphangiography but were unexpected clinically.

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