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Year : 2003  |  Volume : 13  |  Issue : 1  |  Page : 120-121
Cystic hygroma of chest wall


Department of Radiodiagnosis, LHMC, India

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How to cite this article:
Arora A, Narula M K, Sonkar P, Chadha R. Cystic hygroma of chest wall. Indian J Radiol Imaging 2003;13:120-1

How to cite this URL:
Arora A, Narula M K, Sonkar P, Chadha R. Cystic hygroma of chest wall. Indian J Radiol Imaging [serial online] 2003 [cited 2020 Aug 14];13:120-1. Available from: http://www.ijri.org/text.asp?2003/13/1/120/28644
Sir,

A two and a half year old female child presented to the pediatric department with a lump in the right chest wall (the mammary region) since birth. The swelling was slow growing. There was no overlying skin discoloration, ulceration or discharge. Transillumination test was positive. The child was in good health and showed normal developmental milestones. There was no evidence of any other associated anomaly.

Ultrasonographic examination revealed a well marginated, lobulated, predominantly cystic mass with multiple septations of varying thickness [Figure - 1]. On colour flow imaging, no vascularity was noted. The extent of the lesion was better delineated on CT. It appeared as a lobulated cystic mass of fluid attenuation within the subcutaneous tissue of the right chest wall abutting the right pectoralis major muscle [Figure - 2]. A diagnosis of a lymphangiomatous malformation was considerd. Aspiration revealed chylous fluid and showed few endothelial cells and stromal elements suggestive of lymphatic malformation (cystic hygroma). Post sclerosant Ultrasonography revealed marked reduction in the size of the cystic component and increased echogenicity of the solid components within the lesion.

Lymphangiomas arise from the lymphatic system sequestered in primitive sacs that fail to achieve communication with normal draining channels. Three histological types based on the size of the abnormal lymphatic spaces are: (a) simple lymphangiomas, which have capillary size lymphatic channels, (b) cavernous lymphangiomas, which contain dilated lymphatics and fibrous adventitia, and (c) cystic hygromas, which are macroscopic multilocular cystic masses. Cystic spaces of varying sizes are lined with a single layer of endothelium and contain serous or milky fluid [1].

Cystic hygromas are usually diagnosed in infancy. They become apparent as an asymptomatic soft tissue mass. These are usually slow growing. Sudden enlargement can occur owing to internal hemorrhage or inflammation. A primarily cystic mass with linear septations of varying thickness and occasionally solid components has been described as characteristic of these tumors. Echogenic components correspond to a cluster of abnormal lymphatic channels too small to be resolved with ultrasound. The thickness and echogenicity of the septae vary with the amount of connective tissue, muscle tissue and adipose tissue present in between the cysts [1]. Computed tomography is helpful in determining the extent and nature of the lesion.

These lesions usually show fluid attenuation (unless complicated by hemorrhage), and are generally poorly marginated and multiseptate. MRI may be used in certain cases for better delineation of the extent of the lesion and its anatomical relations [2].

The differential diagnosis of lymphangiomas at this site includes lipomas, fatty neurofibromas, and cystic schwannoma; although these entities in general are less likely to present as multiseptate cystic lesions [3].

Surgical excision in one or more stages, is the most accepted treatment. Other modalities of treatment have been proposed as adjuvants such as injection of sclerosing agents, aspiration, carbon dioxide laser and radiotherapy [4].

CYSTIC HYGROMA OF THE CHEST WALL is a rare occurrence, with only few case reports worldwide. The presence of a multilocular, multiseptate cystic lesion on Ultrasonography suggested a diagnosis of cystic hygroma in this case.

 
   References Top

1.Sheth S, Nusbaum AR, Hutchings GM, Sanders RC. Cystic hygroma in children: Sonographic-pathologic correlations. Radiology 1987; 162 (3): 821-824.  Back to cited text no. 1    
2.Siegel MJ, Glazer HS, Amour TS, Rosenthal D. Lymphangiomas in children: MR imaging. Radiology 1989; 170: 467-470.  Back to cited text no. 2    
3.Lev S, Lev MH. Imaging of cystic lesions-radiological evaluation of the neck. Radiology clinics of north America 2000; 38(5): 1013-1027.  Back to cited text no. 3    
4.Ardenghy M, Miura Y, Kovach R, Hochberg J. Cystic hygroma of the chest wall: A rare condition. Ann Plast Surg 1996; 37: 211-213.  Back to cited text no. 4  [PUBMED]  

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Correspondence Address:
A Arora
Department of Radiodiagnosis, LHMC
India
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Source of Support: None, Conflict of Interest: None


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