Cystic hygroma of the arm

Case contributed by Dr Yair Glick

Presentation

Fever, enlagement of a congenital mass in the left arm

Patient Data

Age: 2 years
Gender: Male

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 known 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.

Modality: Ultrasound

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.

Case Discussion

The findings are consistent with a cystic hygroma of the arm. The single hypoechoic structure is probably infected, which could explain the acute clinical findings, or hemorrhagic.

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 report 1 and another article which listed 7 cases of cystic hygroma of the upper extremity 2.

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Case Information

rID: 51834
Case created: 9th Mar 2017
Last edited: 21st Apr 2017
System: Paediatrics
Inclusion in quiz mode: Included

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