Presentation
Lethargy and vague abdominal pain.
Patient Data
An ultrasound abdomen at a distant health care facility identified para-aortic lymphadenopathy.
Biateral para-aortic lymphadenopathy - the skin surface markers are present to aid planning for biopsy.
The equipment for the job.
Skin surface markers - usually not commercially available, one can make one by cutting up an angiographic catheter (as shown).
Extensive bilateral para-aortic lymphadenopathy, biopsied under CT control.
Co-axial needle in position in the right paraspinal region, prior to core biopsy of the right para-aortic lymph node
Case Discussion
The initial CT chest, abdomen and pelvis revealed bilateral para-aortic lymphadenopathy. No primary source was detected. No supra-diaphragmatic lymphadenopathy.
CT guided biopsy with a 18G co-axial needle performed with the patient in the prone position.
This offered the safest, most assessible route for the least invasion way to make a definitive diagnosis.
With the co-axial needle tip 'parked' just before the chosen lymph node, with a 2cm throw, the renal vessels draped over the anterior aspect of the lymph node are not in danger.
Histopathological analysis confirmed a anaplastic lymphoma.