Recurrent cystic hygroma - adult

Case contributed by Chris O'Donnell
Diagnosis almost certain

Presentation

Previous history of cystic hygroma excision from the left posterior neck as a young adult. Recent pregnancy. Now minimally painful swelling in the left neck at site of previous surgery.

Patient Data

Age: 30 years
Gender: Female
ultrasound

Heterogeneous (mixed solid and cystic mass) sitting behind the parotid and deep to the sternomastoid muscle.  Minimal internal blood flow on color Doppler.

Neck

mri

A well-defined T2 hyperintense mass with internal septations but no flow voids, sitting behind the parotid gland.

Case Discussion

A cystic hygroma (or haemangiolymphoma) is a benign congenital proliferation of lymphoid tissue. It is well recognized in pediatric practice but seldom presents in adulthood.

Hygromas are probably the result of sequestration of fetal lymphatic tissue that has retained its potential for growth. Three types are described: (1) capillary - characterized by small, thin-walled lymphatic channels, (2) cavernous - large channels with a fibrous coat; and (3) cystic - characterized by large cystic endothelial-lined spaces.

The treatment of choice is surgical excision but this can be technically demanding, especially if there is deep extension. Recurrence can occur if the lesion is not fully excised.

On imaging the major differential diagnosis is hemangioma.

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