Cystic hygroma

Case contributed by Dr Laughlin Dawes

The mediastinum is displaced to the right by a superior mediastinal mass. The trachea is displaced and compressed. There is subtle asymmetry of the soft tissues of the upper limbs, with increased density seen on the left. 

Case Discussion

A CT scan was performed which showed a cystic superior mediastinal mass, and hypertrophy of the left upper limb.

Cystic hygroma (lymphatic vascular malformation) is a rare benign lesion, accounting for 1-5% of mediastinal tumours. Most are detected by age two, presenting with pain, dyspnoea, infection, haemorrhage or respiratory compromise. Cystic hygroma is more common in the neck and axilla, with only 5% of cases limited to the mediastinum. Lymphatic vascular malformations may be mixed with other forms of vascular malformation, including capillary or venous. There is an association with limb hypertrophy.

Usually well-circumscribed and of fluid density, cystic hygromas may also have an infiltrative appearance, and may be uni- or multilocular. The density can also be variable with a combination of fluid, soft-tissue density and fat.

Management may be by surgical excision or by injection with OK-432, a preparation containing Streptococcus pyogenes antigens, which induces an inflammatory response and subsequent obliteration of the abnormal cavities. OK-432 injection was performed in this case, with good initial results.

Image contributed by: Dr Laughlin Dawes.

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Case information

rID: 36007
Published: 12th May 2015
Last edited: 6th Nov 2015
Systems: Chest, Paediatrics
Inclusion in quiz mode: Included

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