Lymph retroperitoneal

Most patients with HL present with a painless, rubbery lymph node. Adenopathy is usually localized to the cervical region but can also occur in the mediastinal, hilar, and retroperitoneal regions. 

Baniel J, Foster RS, Rowland RG, Bihrle R, Donohue JP. Complications of post-chemotherapy retroperitoneal lymph node dissection. J Urol 1995 153(3 Pt 2) 976-80. 

Serious fibrotic changes occur in about 1% of patients who take methysergide continuously for 1 year or more, and provide the main reason for reducing doses and withdrawing the drug at intervals. Most commonly the fibrosis is retroperitoneal and starts in the pelvis or the lumbar region, where it can constrict the ureters, arteries, veins, and lymph vessels. Both infarction and obstruction of the bowel have occasionally been described. Fibrotic syndromes elsewhere can involve the heart, pleura, chest wall, and lungs. 

Radiographic imaging studies evaluate the extent of disease involvement. A chest x-ray should be performed to rule out the presence of metastatic spread to the lungs. A CT scan of the abdomen and pelvis is often performed to evaluate hepatic and retroperitoneal involvement and occult abdominal and pelvic disease, and to determine the depth of tumor penetration into the bowel wall and/or invasion to adjacent organs. Detection of lymph node involvement with either smdy is limited by the difficulty of distinguishing inflammatory or reactive lymph nodes from those infiltrated with tumor. Because CT scans may not adequately detect peritoneal seeding, small distant lymph node metastasis, or liver metastasis in colon cancer, an occasional patient may... 

Late metastasis Early metastases to retroperitoneal lymph nodes... 

Memel DS, Dodd GD, Esola CC (1996) Efficacy of sonography as a guidance technique for biopsy of abdominal, pelvic and retroperitoneal lymph nodes. Am J Roentgenol 167 957-962... 

The body phased-array coils available today allow imaging of the entire abdomen with high resolution and should be used whenever available to assess retroperitoneal lymph nodes in addition to evaluating the regional pelvic lymph nodes in all MRl examinations of a primary pelvic tumor. In patients with cervical or endometrial cancer, the demonstration of suspicious retroperitoneal lymph nodes is important for therapeutic planning in patients scheduled for postoperative radiotherapy. 

Recommended for high-resolution imaging of retroperitoneal lymph nodes (with administration of spasmolytic agent)... 

Fig. 15.2. Retroperitoneal lymph nodes. 1, coelical lymph nodes 2 and 3, mesenterial lymph nodes 4, paracaval lymph nodes 5, precaval lymph nodes 6, interaortocaval lymph nodes 7, preaortic lymph nodes 8, paraaortic lymph nodes 9, external iliac lymph nodes 10, internal iliac lymph nodes...

Fig. 15.6. Retroperitoneal (para-aortic) lymph node metastasis in a patient with endometrial cancer (arrow). Axial T2w TSE image obtained with respiratory triggering using the navigator technique...

These techniques also play an important role in evaluating the peri-lesional soft tissue and, particularly, the tumoral involvement of lymph nodes and retroperitoneal fat, corresponding to the retroportal pancreatic margin (Baek et al. 2001 Brugel et al. 2004). 

MRI and CT are used for staging regional and retroperitoneal lymph nodes. 

In the follow-up of these younger patients, the MRI with a lack of radiation should be used to exclude retroperitoneal and iliac lymph nodes. 

MRI shows very good results in staging prostate cancer, with correct staging results in up to 90%. Additional techniques like spectroscopy and perfusion allow improving the specificity. Sonography is the diagnostic modality of choice in case of testicular cancer CT or MRI is performed to rule out retroperitoneal lymph nodes. 

Nahar Saikia et al. (2002) performed 242 aspiration biopsies of deep-seated thoracic, abdominal, and retroperitoneal lymph nodes under US n = 216) and CT n = 26) guidance, respectively. Diagnostic accuracy rate was 86%. 

Luning M etal. (1985) CT guided percutaneous fine-needle biopsy of the pancreas. Eur J Radiol 5 104-108 Memel DS et al. (1996) Efficacy of sonography as a guidance technique for biopsy of abdominal, pelvic, and retroperitoneal lymph nodes. AJR Am J Roentgenol 167 957-962 Mueller PR (1993) Pancreatic biopsy striving for excellence. Radiology 187 15-16... 

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