Introduction

Novel technique to directly access lymph nodes and inject radiographic contrast, revolutionizing the imaging evaluation of the lymphatic vessels in pediatric patients.​​

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Indications

• Abnormal lymphatic flow or leak

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Contraindication

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Pre-Procedure

• Review imaging
• Run the appropriate labs
• Consider draining fluid related to ascites or pleural effusion, as they may cause dielectric artifacts.

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Labs

• CBC
• Hemoglobin
  
• ALC
  
• Electrolytes (sodium, potassium, calcium)
  
• Blood glucose
  
• Blood urea nitrogen
  
• Total protein and albumin
  
• Serum triglycerides and cholesterol
  
• Liver function tests
  
• Serum levels of fat soluble vitamins
  
• Coagulation factors
  
• Immunoglobin levels (IgG,IgM)
  
• TSH
  
• Free thyroxine (T4) - Glucose, and fecal alpha-1-antitrypsin levels
  
• Renal functions are also assessed as a safety precaution prior to any gadolinium administration.  

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Technique

Accessing Lymph Nodes

• An initial ultrasound to select suitable sized lymph nodes in the inguinal areas.
• 22- to 25-gauge hypodermic needles or 20-22-gauge angiocatheters used to access the lymph nodes. Tubing is connected via a three-way stopcock connected to 3 ml contrast and 10 ml saline/sterile water syringes.

MRI Technique

• Imaging coverage area includes upper third of the thigh to neck craniocaudally.
• Common sequences are
  1. T2-weighted imaging;
     
  2. pre and post contrast T1-weighted dynamic MR imaging;
     
  3. pre and post contrast steady state free precession (SSFP) balanced EKG triggered sequence with fat-suppression (3D FIESTA)
     
• X

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Complications

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Post-Procedure

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Follow-up

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References