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.