Cystic hygroma in an adult

Case contributed by Dr Chris O'Donnell

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
Gender: Female
Modality: Ultrasound

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

MRI for clarification of US findings

Modality: MRI

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 recognised in paediatric 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 - characterised by small, thin-walled lymphatic channels, (2) cavernous - large channels with a fibrous coat; and (3) cystic - characterised 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 diffrential diagnosis is haemangioma.

 

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Case Information

rID: 30258
Case created: 29th Jul 2014
Last edited: 20th Nov 2015
System: Head & Neck
Inclusion in quiz mode: Included

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