case_images: PMC10476230_01
case_images: MR lymphangiography in a 15-year-old child with postoperative chylous ascites. The central conducting lymphatics were interpreted as normal in this child. (a) Coronal heavily T2-weighted MRI images of the abdomen with thin Maximum Intensity Projection (MIP) reconstruction depicted a normal cisterna chyli (white arrow). (b) Coronal pre-contrast T1-weighted image of abdomen and pelvis and (c) coronal T1-weighted image of abdomen and pelvis at 7 min after nodal contrast injection demonstrated normal opacification of the cisterna chyli (bold arrow) with faint opacification of the thoracic duct (arrow head). Contrast was still visible in the lumbar lymphatics (arrow). No intraperitoneal leak of contrast was seen. (d) The central conducting lymphatics were highlighted in the subtracted image depicting the cisterna chyli (bold arrow) and thoracic duct (arrow head). (e) Axial T1-weighted image 5 min after intranodal contrast administration showed confluence of the bilateral lumbar lymphatics to form the cisterna chyli (arrow) at the level of renal hilum. (f) Axial T1-weighted image of the upper abdomen 9 min after intranodal contrast administration depicted a normal thoracic duct (arrow). A pancreatic pseudocyst (arrow head) was seen anterior to it.
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case_images: PMC10476230_01_SAJR-27-2703-g001.jpg
case_images: F0001
case_images: A normal calibre and course of cisterna chyli was seen on coronal heavily T2-weighted images (Figure 1a). Post nodal contrast scans revealed the right and left lumbar lymphatic channels, joining to form the cisterna chyli (Figure 1e), followed by opacification of the thoracic duct on subsequent images (Figure 1c, d and f).
case_images: Fluoroscopic nodal lymphangiography was performed in the same child for diagnostic and therapeutic purposes. (a) Fluoroscopic images showed contrast injected in bilateral groin nodes. (b) Fluoroscopic image 30 min after intranodal lipiodol injection depicted a normal cisterna chyli (arrow) and lumbar lymphatics (arrowhead). No intraperitoneal contrast leak was seen. Coronal reformatted CT images post fluoroscopic lymphangiography with thin MIP reconstruction of the abdomen and pelvis (c) and chest (d) demonstrated normal opacification of the lumbar lymphatics (arrow in c) and normal opacification of the cisterna chyli (arrow in d) and thoracic duct (arrowhead in d).
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case_images: PMC10476230_01_SAJR-27-2703-g002.jpg
case_images: F0002
case_images: Following the administration of lipiodol through the inguinal nodes, multiple spot images were obtained of the pelvic and retroperitoneal lymphatics (Figure 2a and b). Post-procedural CT also revealed normal anatomy of the centrally conducting lymphatic channels without contrast extravasation (Figure 2c and d).
case_images: PMC10476230_02
case_images: Ultrasound of the groin (a) and abdomen (b) in an 8-year-old male with disseminated tuberculosis showed (a) enlarged inguinal nodes (arrow) and (b) multiple enlarged abdominal lymph nodes (arrow).
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case_images: PMC10476230_02_SAJR-27-2703-g003.jpg
case_images: F0003
case_images: Ultrasonography revealed hepatomegaly with multiple hypoechoic liver nodules, enlarged necrotic lymph nodes (Figure 3a and b) and gross ascites.
case_images: Dynamic contrast enhanced MR lymphangiography was performed in the same child for chylous ascites. (a) Coronal pre-contrast T1-weighted image of the abdomen and pelvis and (b) coronal T1-weighted image of the abdomen and pelvis at 10 min after nodal contrast injection showed dilated lumbar lymphatics (arrow) and non-opacification of the central conducting lymphatics. (c) Axial T1-weighted image of the abdomen 30 min after intranodal contrast administration showed non-opacification of the central conducting lymphatics. Contrast opacification was noted in the renal pelvis. Enlarged abdominal lymph nodes could also be seen (arrow head). (d) Axial T1-weighted image of the chest 40 min after intranodal contrast administration showed non-opacification of the thoracic duct in the mediastinum but contrast opacification was visible in the superior vena cava (arrow). Enlarged lymph nodes were seen in the anterior mediastinum (arrow head).
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case_images: PMC10476230_02_SAJR-27-2703-g004.jpg
case_images: F0004
case_images: The scan revealed dilated bilateral lumbar lymphatics that were opacified within a few minutes of contrast injection with non-opacification of the cisterna chyli (Figure 4b). The CLLs remained unopacified on delayed phase imaging due to compression by enlarged retroperitoneal lymph nodes (Figure 4c and d).
case_images: Case 2 (a) axial pre-contrast T1-weighted image of the pelvis and (b) axial T1-weighted image of the pelvis 12 min after intranodal contrast administration depicted leakage of contrast in the pelvic free fluid (arrow). (c) The leak was highlighted in the subtracted image (arrow).
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case_images: PMC10476230_02_SAJR-27-2703-g005.jpg
case_images: F0005
case_images: Contrast accumulation was seen in the pelvic free fluid on subsequent images (Figure 5).