EBUS/EUS-guided lymph nodal gadolinium injection and MRI of the chest in diagnosis of abnormal lymphatic drainage. A case series

Mediastinal lymphatic circulation may be disrupted as a consequence of congenital malformations, traumatic injury, or neoplastic infiltration. Such dysfunction can lead to a spectrum of clinical manifestations, most notably chylothorax, plastic bronchitis, and/or alveolar fatty pneumonitis. Although lymphography— traditionally involving the injection of contrast agents into peripheral lymph nodes—was historically utilised for diagnostic purposes, its application has been limited by considerable technical demands and challenges in image interpretation. Herein, we describe three cases of patients admitted to our institution with heterogeneous clinical presentations, including recurrent chylothorax, alveolar fatty pneumonitis, plastic bronchitis, and/or respiratory failure. A definitive diagnosis was established through the administration of 2 mL of gadolinium-based contrast medium into mediastinal lymph nodes under either endobronchial ultrasound (EBUS) or endoscopic ultrasound (EUS) guidance, with magnetic resonance imaging (MRI) performed both prior to and following the injection to evaluate contrast distribution.