Presentation
Swelling of the anterior aspect of the distal right thigh, known since birth, rapidly increased in size and becoming painful following trauma.
Patient Data
There is a well-defined cystic lesion with echogenic lace-like reticular content and posterior enhancement. No soft tissue component or calcification is seen.
There is a well-circumscribed multiloculated, multiseptated cystic mass measuring 6 x 5 x 2 cm of the anterior aspect of the right distal thigh, anterior to the vastus lateralis muscle and quadriceps femori tendons. It elicits an iso-to slight high signal on T1 and a high signal on T2 with a sediment of a low signal (intracystic hemorrhage). The postcontrast sequences show a heterogeneous enhancement mainly of the septa with edematous infiltration of the surrounding subcutaneous fatty tissue. No intra- or intermuscular extension.
Case Discussion
Ultrasound and MRI features most consistent with a cystic lymphangioma with post traumatic internal bleeding.
Intracystic hemorrhage and infection are the main complications of cystic lymphangiomas.