Ultrasound, Lymph Nodes and Retroperitoneum

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Ultrasound, Lymph Nodes and Retroperitoneum

Synonym/acronym: Lymph node sonography.

Common use

To visualize and assess for lymph node enlargement related to disorders such as infection, abscess, tumor, and cancer. Also used as a tool to biopsy and evaluate the progress of therapeutic interventions.

Area of application

Abdomen, pelvis, and retroperitoneum.

Contrast

Done without contrast.

Description

Ultrasound (US) procedures are diagnostic, noninvasive, and relatively inexpensive. They take a short time to complete, do not use radiation, and cause no harm to the patient. High-frequency sound waves of various intensities are delivered by a transducer, a flashlight-shaped device, pressed against the skin. The waves are bounced back off internal anatomical structures and fluids, converted to electrical energy, amplified by the transducer, and displayed as images on a monitor. US is often used as a diagnostic and therapeutic tool for guiding minimally invasive procedures such as needle biopsies and fluid aspiration. The contraindications and complications for biopsy and fluid aspiration are discussed in detail in the individual monographs.

Lymph node US is used to evaluate the structure, size, and position of the lymph nodes to examine the retroperitoneum and surrounding tissues. This procedure is used for the evaluation of retroperitoneal pathology, usually lymph node enlargement. US is the preferred diagnostic method because this area is inaccessible to conventional radiography in diagnosing lymphadenopathy, although it can be used in combination with lymphangiography, magnetic resonance imaging (MRI), and computed tomography (CT) to confirm the diagnosis. The procedure may be used for monitoring the effect of radiation or chemotherapy on the lymph nodes.

This procedure is contraindicated for

    N/A

Indications

  • Detect lymphoma
  • Determine the location of enlarged nodes to plan radiation and other therapy
  • Determine the size or enlargement of aortic and iliac lymph nodes
  • Evaluate the effects of medical, radiation, or surgical therapy on the size of nodes or tumors, as evidenced by shrinkage or continued presence of the mass or nodes

Potential diagnosis

Normal findings

  • Normal retroperitoneal and intrapelvic node size of 1.5 cm in diameter

Abnormal findings related to

  • Infection or abscess
  • Lymphoma
  • Retroperitoneal tumor

Critical findings

    N/A

Interfering factors

  • Factors that may impair clear imaging

    • Incorrect placement of the transducer over the desired test site; quality of the US study is very dependent upon the skill of the ultrasonographer
    • Metallic objects (e.g., jewelry, body rings) within the examination field, which may inhibit organ visualization and cause unclear images
    • Inability of the patient to cooperate or remain still during the procedure because of age, significant pain, or mental status
    • Gas or feces in the gastrointestinal tract resulting from inadequate cleansing or failure to restrict food intake before the study
    • Retained barium from a previous radiological procedure
    • Dehydration, which can cause failure to demonstrate the boundaries between organs and tissue structures
    • Insufficiently full bladder, which fails to push the bowel from the pelvis and the uterus from the symphysis pubis, thereby prohibiting clear imaging of the pelvic organs in transabdominal imaging
  • Other considerations

    • Failure to follow dietary/fluid instructions and other pretesting preparations may cause the procedure to be canceled or repeated.

Nursing Implications and Procedure

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this procedure can assist in assessing the lymph nodes and surrounding tissue.
  • Obtain a history of the patient’s complaints or clinical symptoms, including a list of known allergens, especially allergies or sensitivities to latex.
  • Obtain a history of the patient’s immune system, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Note any recent procedures that can interfere with test results (i.e., barium procedures, surgery, or biopsy). There should be 24 hr between administration of barium and this test.
  • Endoscopic retrograde cholangiopancreatography, colonoscopy, and CT of the abdomen, if ordered, should be scheduled after this procedure.
  • Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
  • Review the procedure with the patient. Address concerns about pain related to the procedure and explain that some pain may be experienced during the test, and there may be moments of discomfort. Inform the patient that the procedure is performed in a US department by a health-care provider (HCP) who specializes in this procedure, with support staff, and takes approximately 30 to 60 min.
  • Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Instruct the patient to remove jewelry and other metallic objects from the area to be examined.
  • Instruct the patient to fast and restrict fluids for 8 hr prior to the procedure. Inform the patient that transabdominal US requires a full bladder. Protocols may vary among facilities.
  • Instruct the patient to drink three to four glasses of fluid 90 min before the procedure, and not to void before the procedure.

Intratest

  • Potential complications: N/A
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient.
  • Ensure that food and fluids have been restricted for at least 8 hr prior to the procedure.
  • Ensure that the patient receiving transabdominal US drank three to four glasses of fluid and has not voided.
  • Ensure that the patient has removed all external metallic objects from the area to be examined prior to the procedure.
  • Instruct the patient to change into the gown, robe, and foot coverings provided.
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Instruct the patient to cooperate fully and to follow directions. Ask the patient to remain still throughout the procedure because movement produces unreliable results.
  • Place the patient in the supine position on an examination table; other positions may be used during the examination.
  • Expose the abdominal area and drape the patient.
  • Conductive gel is applied to the skin, and a transducer is moved over the skin while the bladder is distended to obtain images of the area of interest.
  • Ask the patient to breathe normally during the examination. If necessary for better organ visualization, ask the patient to inhale deeply and hold his or her breath.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
  • Allow the patient to void, as needed.
  • When the study is completed, remove the gel from the skin.
  • Instruct the patient to resume usual diet and fluids, as directed by the HCP.
  • Recognize anxiety related to test results. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate.
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

  • Related tests include angiography abdomen, biopsy bone marrow, biopsy lymph nodes, CBC, CBC hemoglobin, CBC RBC count, CBC RBC morphology and inclusions, CT abdomen, CT colonoscopy, ESR, gallium scan, KUB study, laparoscopy abdominal, lymphangiogram, and MRI abdomen.
  • Refer to the Immune System table at the end of the book for related tests by body system.