Lymphatics are the very small vessels that carry fluid from the tissue back to the body’s circulation. Although they sound small, when they don’t work right they can cause big problems. Our Nemours lymphatics team checks for and treats lymphatic disease such as:

• chylothorax (when lymphatic fluid flows into the area between the lungs and chest wall, which protects the lungs)
• chylous ascites (also called “chylous effusions” — when lymphatic fluid builds up in the belly or chest cavity, the airtight box that houses things like the lungs and heart)
• chyluria (when lymphatic fluid enters the urine, or pee, and makes it look milky white)
• lymphangiectasia (when lymphatic fluid stays in the tissue)
• plastic bronchitis (when lymphatic fluid builds up in, hardens and blocks the airways, causing breathing problems)
• protein-losing enteropathy (when the body loses protein in the intestines, causing belly pain and diarrhea)

The Nemours Lymphatic Imaging & Therapeutics Program offers a wide range of services for kids with lymphatic disorders, their families and their referring physicians.

Step 1: Diagnosis

In the past, it was hard for doctors to understand what the problem was. That’s because the lymphatic vessels were too small for the available imaging options. But in recent years, we’ve developed methods of imaging that allow us to not only see the actual lymphatic vessels, but even watch them in action.

If a vessel is leaking or blocked, we can spot this in real time with imaging tests called “lymphangiography.” We inject a dye into the lymphatic system, either through lymph nodes (small clumps of tissue located along the network of lymph vessels) or through the lymph vessels themselves. Then we watch under a live X-ray called “fluoroscopy” to see what’s going on. We can now see even more detail by using both X-ray and magnetic resonance imaging (MRI). An MRI is a large doughnut-shaped scanner that gives detailed images using a magnetic field and sound waves instead of radiation.

Step 2: Treatment

Once we figure out the problem, we have a number of tools and ways to fix lymphatic disorders. If the lymphatic vessel is leaking, we block off the leak. If the vessel is closed off, we open it. This involves getting into the lymphatic vessels using tiny needles and wires. During these procedures, the interventional radiology team works closely with cardiologists, pulmonologists and gastroenterologists (GI doctors) to help guide the treatment and reduce risks. Interventional radiology (IR) is the use of medical imaging techniques (such as an ultrasound, CAT scan or fluoroscopy) to guide doctors as they diagnose and treat problems. IR techniques are minimally invasive, which means we use tiny incisions (cuts). And that often means shorter recovery times, very small or no scars, and less pain.

At the Nemours Lymphatic Imaging & Therapeutics Program we offer complete diagnosis, evaluation and treatment for children with lymphatic disease. If a physician refers your child to us, up to a dozen of our lymphatics team doctors will review your child’s case so we can work together to decide on the next steps. We combine the expertise of our large team of experts with Nemours’ family-centered care. That means we involve you and your child in deciding on a plan of care. And we make sure your family understands what’s happening every step of the way.

Lymphatics Program Highlights