Lymphangiomas are benign lesions of vascular origin that show lymphatic differentiation. It is considered the lymphatic equivalent of a haemangioma of blood vessels.
This article focuses the general features of lymphangiomas. For a specific discussion in other locations, please refer to the articles:
They can present at any age but most often occur in the paediatric population (~90% in those less than 2 years old 3).
Generally, the presentation may be with symptoms related to local mass effect and/or haemorrhage. For example, a lymphangioma within the orbit may present with progressive proptosis with acute deterioration in symptoms, the mass effect resulting in compressive optic neuropathy, diplopia/ocular muscle weakness and orbital bruising.
Typically comprised of thin-walled cystic masses and may contain:
- large macroscopic interconnecting cysts: cystic hygroma or cystic lymphangioma
- microscopic cysts: cavernous lymphangioma
Their wall consists of connective tissue, smooth muscle, fat, blood vessels, nerve, or lymphatic tissue.
They can occur at almost any location:
- marked predilection in the head and neck: 95% in the neck and axillary regions
- mesentery, retroperitoneum, abdominal viscera, lung, and mediastinum: ~5%
There are several recognised subtypes:
- cystic hygroma: cystic lymphangioma
- cavernous lymphangioma
- simple capillary lymphangioma
- lymphovascular malformation: e.g. venolymphatic malformation
Most lymphangiomas appear homogeneous and cystic on CT, but some appear inhomogeneous because of the presence of proteinaceous, fluid, blood, or fat components within the lesion. It is rare for CT to demonstrate intrinsic septations. There is only minimal or no displacement/compression of adjacent structures.
Fluid-fluid levels may be seen if complicated by haemorrhage. Signal characteristics include:
- T1: can be variable especially dependent on protein content
- T2: usually high signal
Treatment and prognosis
Surgical excision or interventional sclerotherapy is often necessary 3.
Possible imaging differential considerations include:
- 1. Levy AD, Cantisani V, Miettinen M. Abdominal lymphangiomas: imaging features with pathologic correlation. AJR Am J Roentgenol. 2004;182 (6): 1485-91. AJR Am J Roentgenol (full text) - Pubmed citation
- 2. Shaffer K, Rosado-de-christenson ML, Patz EF et-al. Thoracic lymphangioma in adults: CT and MR imaging features. AJR Am J Roentgenol. 1994;162 (2): 283-9. AJR Am J Roentgenol (abstract) - Pubmed citation
- 3. Ha J, Yu YC, Lannigan F. A review of the management of lymphangiomas. (2014) Current pediatric reviews. 10 (3): 238-48. Pubmed