5-day-old child presents with a neck swelling. A CT scan of the neck is
Imaging Findings reveal a low-attenuation mass lesion in the cervical region, which was noted extending to the axilla.
Some believe cystic hygroma is caused by an abnormal embryonic sequestration of lymphatic tissue and its subsequent failure to join normal lymphatic channels, while a third theory suggests that abnormal budding of the lymphatics occurs between the sixth and ninth weeks of gestation. These then canalize to form lymph-filled cysts.
Of these three theories, the first seems the most likely. However, the other two theories could be applied to noncervical lymphangyomatosis.
simple lymphangioma, formed by lymphatic capillaries;
cavernous lymphangioma, formed by bigger lymphatic vessels with a fibrous adventitia;
lymphangioma, commonly called hygroma, formed by multiple cysts
ranging from a few millimeters to several centimeters in size.
No communication exists between the lymphatic system and a cystic hygroma. Cystic hygromas have a predilection for local infiltration of the dermis, subcutaneous tissue, and soft tissue, and occasionally they are widespread.
About 50% of these are present at birth, and up to 90% become evident by two years of age. The incidence of cystic hygroma is approximately 1.6:10,000 pregnancies or 0.8% of pregnancies at risk for a structural anomaly.
The site of the lesion determines
the symptomology. Many patients have no symptoms other than a soft tumor
mass. Oral cavity and laryngeal involvement can produce stridor, dyspnea,
and feeding difficulties.
Diagnosis in the case of large
cervical LM is straightforward. The mass is soft, flaccid, fluctuant, with
a multilobulated consistency. Imaging studies such as USG, CT, and MRI can
be useful in treatment planning. In particular, CT and MRI are most useful
in determining proximity to vital structures and mediastinal involvement