Macrocystic lymphatic malformation of the arm

Case contributed by Dr Yair Glick

Presentation

Fever, enlargement of a congenital mass in the left arm

Patient Data

Age: 2 years
Gender: Male

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 discernible 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

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 discolouration or a well-defined mass.

The ultrasonographic findings are consistent with a macrocystic lymphatic malformation of the arm. The single hypoechoic structure is either hemorrhagic or infected.

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