Cystic hygroma of the arm
Fever, enlargement of a congenital mass in the left arm
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A chain of numerous anechoic structures is located between the subcutaneous fat and the lateral aspect of the deltoid and biceps brachii muscles, extending from the shoulder to the elbow. Several of them appear to be interconnected. No visible internal flow.
Immediately proximal to the elbow there is a larger hypoechoic structure measuring 3.7 x 1.8 cm with no apparent internal flow.
A two-year-old boy presented to the emergency department with new-onset fever. The boy's mother mentioned that a mass in the boy's left arm present since birth had grown larger several days previously. Of note, the boy had never had workup for the mass. The boy was examined by a surgeon, who noted a bulge just above the elbow with focal warmth and fluctuation, and referred him for soft tissue ultrasound of the arm.
On commencement of the ultrasound examination, the arm was noted to be uniformly swollen, without any skin discoloration or a well-defined mass.
The ultrasonographic findings are consistent with a cystic hygroma of the arm. The single hypoechoic structure is probably infected, which could explain the clinical symptoms, or haemorrhagic.
Cystic hygroma is a type of congenital lymphangioma. The vast majority of cases occur in the neck or the axilla. Barring the axilla, cystic hygroma of the upper extremity is extremely rare; a Pubmed search for cystic hygroma of the arm/upper extermity yielded a single case report 1 and another study which listed 7 cases of cystic hygroma of the upper extremity 2.
- 1. Carpenter CT, Pitcher JD, Davis BJ, Gomez R, Schofield TD, Youngberg RA. Cystic hygroma of the arm: a case report and review of the literature. Skeletal radiology. 25 (2): 201-4. Pubmed
- 2. Eliasson JJ, Weiss I, Høgevold HE, Oliver N, Andersen R, Try K, Tønseth KA. An 8-year population description from a national treatment centre on lymphatic malformations. Journal of plastic surgery and hand surgery. doi:10.1080/2000656X.2016.1254092 - Pubmed