Cervical Intranodal Lymphangiogram in Pediatrics; Technique, Safety, and Clinical Applications.

Purpose: This paper introduces a novel technique, cervical lymphangiogram, involving intranodal lymphangiogram through cervical lymph nodes. We will discuss our preliminary experience regarding the technique, safety, and applications, offering a promising approach to addressing central conducting duct opacification challenges.

Material and methods: This retrospective study was IRB exempt. All patients failed conservative management for treatment of chylous effusion. Patients who underwent cervical lymphangiogram as either diagnostic or therapeutic process were included. All patients were imaged with magnetic resonance lymphangiogram (MRL) followed by fluoroscopic inguinal intranodal lymphangiogram with failure to opacify thoracic duct or source of chylous effusion. Both, intranodal lymphangiograms and MRL were performed using water-soluble contrast due to the risk of paradoxical emboli given either suspected or confirmed right-to-left shunts.

Results: Cervical lymphangiogram was performed on 7 patients with ages ranging from 40 days to 8 years. Etiology included unilateral or bilateral chylous pleural effusions. Technical success (defined as opacification of thoracic duct depicting its anatomy, revealing the underlying disorder, either a leak or congenital anomaly) rate was 100%. Clinical success (defined by resolution of symptoms) rate was 100% in patients that showed evidence of leak and underwent glue embolization (6 out of 7 patients). No technique-related complications incurred in any patients. The mean follow-up duration to exclude recurrence and watch for complications was 150 days.

Conclusion: Cervical lymphangiogram is a promising and safe technique to evaluate central conducting ducts where inguinal lymphangiograms (intranodal or MRL) have failed to demonstrate the same.