<p>The technique of intranodal contrast injection to visualize the lymphatic vessels, along with the use of dynamic contrast-enhanced MR lymphangiography, has led to important insights into the phenotype of patients with complex lymphatic anomalies. The pediatric patient with a complex lymphatic anomaly benefits from an integration of therapy across modalities, including supportive strategies (diet), localized therapy (drainage, embolization), and systemic therapy including targeted molecular therapy in mutation-driven complex lymphatic anomalies. A multidisciplinary collaboration, involving pediatricians, pharmacotherapeutic experts, pediatric radiologists, interventional radiologists, surgeons, geneticists, and nutritionists, is essential to tailor diagnosis to genotype and phenotype, personalize treatment, and monitor response.</p> Graphical Abstract <p></p>