Mr lymphangiographies

Hi,

Are any of you folk coding these? MR Lymphangiographies?

What do you think would be the proper code(s)?

Margie

Technique: True Fisp Static Axials, T2w 3d Space, Dynamic

Intranodal Time Resolved Contrast Enhanced 3d Mr Lymphangiography

(DCMRL) And Delayed 3d Ir Flash Sequences Were Performed.

Bi-Inguinal Intranodal Magnevist Was Given By Dr Followed By

Saline Flush. Post Processing Multiplanar Volume Rendered

Reconstructions Were Done.

Sedation: Images Were Obtained With GETA .

Comparison: No previous lymphatic MR studies.

Comments: In The Upper Abdomen, The Spleen Is on the left. The

Gastric Fundus is on the left and the Liver Is on the right.

T2 weighted lymphatic mapping demonstrated moderate pleural

effusion on the left and mild amount of pleural fluid on the

right. There is a small pericardial effusion. There is diffuse T2

enhancement in the lumbar regions all the way up to the

retroperitoneal space in the abdomen surrounding the aorta and

the IVC. There is also diffuse bilateral T2 enhancement in the

interstitial lung spaces as well as in the mediastinum and

bilateral supraclavicular and cervical regions. These findings

are suggestive of a diffuse lymphoproliferative disorder

consistent with lymphangiomatosis.

DCMRL with injection of contrast into bilateral inguinal lymph

nodes demonstrated dilated and proliferative lumbar lymphatics as

well as abdominal retroperitoneal lymphatics The thoracic duct is

dilated and intact measuring 4.5 mm at its maximal diameter with

brisk flow. At the mid thorax the thoracic duct bifurcates and

then reconstitutes to form a proper thoracic duct that empties

into the left innominate vein. In addition contrast is seen

spilling from the terminal thoracic duct through an additional

channel into the mediastinal and pleural spaces.

High resolution 3D IR FLASH sequence confirmed the DCMRL

findings.

Static true-FISP sequences were performed in the axial plane

using continuous slices to evaluate the heart and will be

reported elsewhere. This report is focused on the lymphatic

system imaging findings not related to the lymphatic system will

not be reported here.

1. Diffuse lymphoproliferative disorder consistent with

lymphangiomatosis.

2. Thoracic duct is dilated with brisk lymphatic flow.

3. Leak of lymphatic fluid from a duct exiting of the terminal

thoracic duct and supplying flow to the mediastinum and pleural

spaces.

Study Result

HISTORY: The patient is a 22 year old female who presents for

cardiac MR for MR lymphangiogram. This report will contain the

anatomic assessment based on the static axial 3-dimensional data

set. The lymphatics data will be interpreted by Dr. Dori in a

separate report.

TECHNIQUE: True FISP static axials, T2 dark blood, time resolved

and IR flash MR lymphangiography.

COMPARISON: No previous cardiac MR studies.

COMMENTS: True FISP and HASTE static axials demonstrate situs

solitus of the atria, ventricular D-loop, and solitus great

arteries. There are normal systemic and pulmonary venous

connections. The patient has a left aortic arch with a normal

branching pattern.

There is a small pericardial effusion. There is a small to

moderate right-sided pleural effusion. There is a moderate sized

left-sided pleural effusion.

Qualitatively, the right ventricle is neither significantly

dilated nor hypertrophied. The right ventricular outflow tract,

main pulmonary artery, and branch pulmonary arteries are

unobstructed.

Qualitatively, the left ventricle is neither significantly

dilated nor hypertrophied. The left ventricular outflow tract and

the entire aorta are unobstructed.

This was a cardiac MRI focusing on the cardiovascular system, the

trachea and their relationships to each other in the chest.

Pathology outside this organ system may not have been fully

evaluated and may not be delineated in this report. Therefore, if

pathology is suggested clinically, other testing should be

performed.

IMPRESSION

1. Normal segmental anatomy. No evidence of volume overload.

2. There is a small pericardial effusion. There is a small to

moderate right-sided pleural effusion. There is a moderate sized

left-sided pleural effusion.

Mr lymphangiographies