A Comparative Study of Intraosseous Cavography and Intravenous Pyelography in the Demonstration of Retroperitoneal Lymphoma

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Abstract
The retroperitoneal space is subject to a variety of tumors. These may originate from retroperitoneal organs or glands, as the kidney, pancreas, and adrenals, or they may arise primarily in retroperitoneal connective, adipose, nervous, muscular, or even embryonic tissue. The lymphatics may be involved by either primary lymphomas or metastatic lesions, the latter being the most common of the retroperitoneal tumors, with lymphomas supplying the majority of the cases (1, 5). Since the diagnosis of retroperitoneal lymphoma is so frequent a clinical problem, it commands special attention. In a considerable number of patients where the clinical evaluation suggests the presence of retroperitoneal node involvement with lymphoma, even the experienced clinician may be unable to delineate the nodes with reasonable certainty. Because the decision in regard to the most dynamic form of radiation therapy depends largely on the exact localization of the tumefactions, the radiologist is usually called upon for aid. He has at his command many procedures of varying technical ease and accuracy: plain roentgenography of the abdomen, laminagraphy, either vertical or horizontal, and a multitude of contrast studies such as intravenous pyelography, gastrointestinal studies, angiography, lymphography (8, 13, 14, 16), and retroperitoneal pneumography (2). According to the size and location of the involvement, one or another of these methods may be especially suited to the problem at hand. The first choice falls to the procedures that are simplest to perform, with the least discomfort to the patient. We were impressed by the many characteristics of the inferior vena cava that make it suitable for demonstrating retroperitoneal masses. It is of a large uniform caliber, passing from the pelvis to the diaphragm, is flexible, and is in close relation to the lymph nodes. This gives it certain advantages over the ureters, which are more variable in their size and course and are not so intimately related to the lymph nodes. The roentgenographic demonstration of the inferior vena cava was reported as early as 1935 by dos Santos (3). Since that time, there have been further reports by O'Loughlin (12), Helander (6, 11) and Kaufman (7). Methods utilized for demonstrating the vessel include bilateral percutaneous injection into the femoral veins, bilateral percutaneous femoral vein catheterization by the Seldinger method, and translumbar injection. It was our purpose to investigate the intraosseous route. One could inject contrast material into the femoral trochanters or the pelvis, but adequate outlining of the vena cava via these sites would require bilateral injection. Fischgold (4), Tori (15), and Lessmann (9) have shown that injection of opaque medium into the spinous process of a vertebra allows visualization of the vertebral plexuses and the inferior vena cava.

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