Understanding the Lymphatic System

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This website has a singular purpose. It aims to promote understanding and highlight the importance of the Lymphatic System. It also seeks to educate about new diagnostic and therapeutic options for the Lymphatic System disorders.
Dr. Maxim Itkin
About Us

Meet Maxim Itkin, MD

Dr. Maxim Itkin, MD, a world-renowned expert in lymphatic disorders and interventional radiology. Dr. Itkin specializes in advanced treatments like thoracic duct embolization, lymphangiography, and chylothorax management, with a focus on complex conditions such as protein-losing enteropathy, plastic bronchitis, and neonatal lymphatic disorders.

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Why the Lymphatic
System is important:

It works together with the vascular system as the conduits of the fluid in the body. The vascular system (arteries and veins) delivers fluids and essential nutrients to the tissues. Meanwhile, the lymphatic system removes fluid, some metabolites, and proteins from the tissues back into venous circulation.

Additionally, the lymphatic system has an immune role, reflected in its active participation in infectious and cancer processes. Nevertheless, this role has already received significant attention and is out of the scope of this website.

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Lymphatic System
About

The Overlooked Importance of the Lymphatic System

The lymphatic system is found throughout the body. Despite its importance, clinical medicine overlooked it for the last half of the century. The reason for this is that it is very difficult to see inside the body. When an average person (and majority of the doctors) thinks about the lymphatic system, they imagine lymphedema and swollen neck lymph nodes, because these are the parts we can see.

The Deep Lymphatic
System

Why is it so difficult to image the “deep” lymphatic system? This is due to the very small size of the lymphatic vessels, extreme complexity and variability of the anatomy, and difficulty of introduction of the contrast. In addition, there were very few therapeutic options.

The Turning Point in Lymphatic Imaging

Everything started to change approximately 25 years ago, when Dr. Constantine Cope , one of the fathers of Interventional Radiology, conceptualized and tested a new procedure: thoracic duct embolization, at the Hospital of University of Pennsylvania. This development started a new page in our exploration and understanding of the contribution of the lymphatic system to variety of pathophysiological processes in the body.

Renewed Interest in Imaging the Lymphatic System

This procedure gave us newfound ability to intervene in the lymphatic system, generating a new interest in imaging of the lymphatic system. Until recently, the only two imaging techniques of the lymphatic vessels were: pedal lymphangiography and lymphoscintigraphy— both were inferior for imaging of the central lymphatic system.

Development of New Imaging Techniques

Approximately 5-6 years ago, new techniques for imaging the lymphatic system were developed. They include:
  • Intranodal lymphangiography (IL)
  • Dynamic Contrast-Enhanced Lymphangiography (DCMRL)
  • Liver lymphangiography
  • Mesenteric lymphangiography, and more.

Diseases Revealed by New Imaging Techniques

All these techniques allowed for the discovery of the pathophysiology of a multitude of diseases, such as:
  • Chylothorax
  • Chylous ascites
  • Plastic bronchitis
  • Protein-losing enteropathy
  • Genital lymphorrhea and swelling
  • Pulmonary insufficiency in patients with lymphatic anomalies

Development of New Interventional Techniques

In addition to these new imaging techniques, several interventional techniques were developed. They include:
  • Thoracic duct embolization
  • Liver lymphatic embolization
  • Interstitial lymphatic embolization
  • TD externalization
  • TD stenting
Disorders

Disorders We Treat

The leak of the lymphatic fluid can lead to in devastating consequences that can jeopardies life due to lose of the important nutrients coagulation and immune factors.
Lymphatic System
Traumatic Chilothorax

Traumatic chylothorax occurs most often due to iatrogenic injury of the thoracic duct and lymphatic system during thoracic, cardiac and ENT surgeries. Read More

Non-traumatic Chylothorax

In this condition the chylothorax occurs spontaneously without recent trauma. It can have associated with disease, such as lymphoma, previous radiation. Read More