Lymphangioma

Dr Owen Kang and Dr Donna D'Souza et al.

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). The world wide incidence of lymphangiomas is 1:6000-16000 live births. Males and females are equally affected.

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. Clinical examination may reveal soft, non-tender masses on palpation with a doughy consistency.

Typically comprised of thin-walled cystic masses and may contain:

Their wall consists of connective tissue, smooth muscle, fat, blood vessels, nerve, or lymphatic tissue. 

They can occur at almost any location:

There are several recognised subtypes, classified according to the size of the lymphatic cavities. In order of increasing size:

  • multilocular cystic masses
  • internal septa of varying thickness
  • cystic contents: usually anechoic, hyperechoic if debris, high lipid concentration, infection or haemorrhage
  • wide variations exist: solid areas, or mostly solid with cystic foci
  • colour Doppler: +/- arterial or venous flow in the septa

In the head and neck region, larger lesions tend to occupy more than one deep space, sandwiching between normal structures.

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

Surgical excision or interventional sclerotherapy (with interferon, OK-432, or bleomycin) is often necessary 3. Other possible treatment methods include steroid therapy, laser treatment, aspiration, radiofrequency ablation, or cautery.

Possible imaging differential considerations include:

  • haemangioma
  • venous malformation: demonstrate internal blood flow and central enhancement
  • other cystic neck masses
    • teratoma: demonstrate fat or calcification
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Article information

rID: 1611
Synonyms or Alternate Spellings:
  • Lymphangiomas
  • Lymphangioma - general
  • Lymphangiomas - general

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Cases and figures

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    Lymphangioma Us 1
    Case 1: abdominal
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    Case 2: cystic hygroma of the arm
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    Case 3: cervical
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