Lymphatic Imaging and Interventions

We are pleased to offer children of all ages the latest minimally invasive techniques in diagnosing and treating problems with the lymphatic system. Until recently, this hidden system of lymph nodes and connecting vessels was hard to capture with medical imaging technology. Thanks to advances in MRI equipment and improvement in delivering dynamic contrast directly into lymph nodes, we are now able to see lymph fluid moving throughout your child’s body. This advancement helps us both diagnose and treat certain conditions that in the past may not have been considered treatable.

With lymphatic interventions and imagery, we can:

• Diagnose the source of lymphatic leaks or abnormal lymphatic drainage.
• Drain lymph that pools in certain areas of the body.
• Repair lymphatic leaks in children with minimally invasive techniques.

As we discover diseases related to abnormal lymphatic drainage, we team up with other specialties, including pediatric cardiology, gastroenterology, dermatology, pulmonology, and hematology, to consider ways we can use this new imaging technology to best care for children with various conditions.

In addition to allowing treatment of difficult conditions, like plastic bronchitis and protein losing enteropathy, this breakthrough in interventional radiology may open the path to discovery in other chronic conditions such as congenital lymphedema or neonatal ascites—both conditions in which diagnostic imaging was very limited in the past.

Repairing lymphatic leaks and draining lymph

Lymphatic leaks are rare, but they can occur as a complication of surgery, radiation therapy, injury, or a heart condition. With our direct internodal MRI lymphangiography imaging technique, we are able to visualize and map your child’s lymph system, precisely locating the source of a lymphatic leak. In this fairly simple procedure, we insert a small needle into one of your child’s lymph nodes and deliver contrast (dye) into the lymph system while your child receives an MRI.

Lymphatic leaks due to heart conditions

With certain heart conditions, such as single ventricle and other congenital heart diseases, lymphatic fluid can collect in the lungs or the abdomen (usually related to higher pressures in the veins), preventing lymph fluid from emptying into the veins correctly. Instead, fluid forms other pathways and accumulates around the lungs. When this happens, we gather a team of pediatric cardiologists, interventional cardiologists, heart failure experts, and interventional radiologists to drain the lymphatic fluid and also to identify the source of the lymph leak using our minimally invasive treatment. Depending on the source of the leak, treatment either blocks the pathway that is leaking or ensures that lymph flow is optimized by treating the cause of the high pressures in the veins. By doing so, we can delay a child’s heart transplant (for single ventricle) and better predict how a child will do with transplant.

We are one of the first programs on the West Coast to provide lymphatic treatments for specific pediatric heart patients. We are continually exploring and discovering more cardiac applications for lymphatic imaging and minimally invasive interventional radiology treatments.

Non-heart-related lymphatic leaks

Lymphatic leaks that are not related to a heart condition often start in the thoracic duct—the body’s largest lymphatic vessel, located in front of the spine between the chest and abdomen. Using direct internodal MRI lymphangiography imaging, we are able to see the origin of the leak. We can then seal the leak by using a special glue in a process called thoracic duct embolization. Not too long ago, repairing the thoracic duct in a child involved open-heart surgery, so we are pleased to offer this leading-edge approach that is safer, is less invasive, and allows children to recover much more quickly. In some patients, fluid collections may be related to abnormal drainage of the lymph fluid not emptying into the veins. These children may still require surgery to repair the problem; however, now we are able to give surgeons a road map to make the process easier.