Macrocystic lymphatic malformation(fetal MRI)

Case contributed by Dr Ashesh Ishwarlal Ranchod

Presentation

Antenatal ultrasound at 27 weeks gestation identified an anterior cervicothoracic mass. Fetal MRI for reassessment.

Patient Data

Age: 20 years
Gender: Female

Multiplanar and multisequence fetal MRI confirmed a well-circumscribed, non-infiltrating, anterior cervicothoracic mass lesion measuring at least 4.6 - 4.8 cm in craniocaudal length, 5.4 cm in width and 5.8cm in the oblique anteroposterior diameter. The mass is eccentric towards the right with extension left and right of the central anterosuperior thorax. The mass is subcutaneous and superficial. It has a mild increased T2 signal intensity and isointense to low T1 signal intensity with a macrocystic and multilocular appearance. There is no intralesional hemorrhage, no flow voids are present and no obvious features to suggest calcification. Intralesional septae are appreciated.There is no intramediastinal extension. The visualized airway appeared patent and non-compromised. The visualized lungs, heart and mediastinum appear normal.

Fetal brain maturation, gyration and sulcation are age appropriate. The rest of the examination appeared normal.

Case Discussion

At 10 days of age, complete excision histology confirmed a benign, macrocystic lymphatic malformation lymphangioma ( commonly known as cystic hygroma or cystic lymphangioma).

These lesions commonly occur in the neck and axillae, with a minority of cases involving the neck and mediastinum. Differential diagnosis would include the broad categories of anterior and post cervical/thoracic mass lesions and would include cervical/mediastinal teratoma, cervical meningocele, occipital encephalocele, thymic masses, and neurogenic tumors.

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