Presentation
Abdominal pain unrelated to food, nausea and postprandial distension.
Patient Data
Cholangioresonance showed a multilobulated cystic lesion near the hepatic hilum without bile duct involvement or dependence on hepatic or pancreatic parenchyma. Additionally, a simple hepatic cyst is observed.
The patient was sent for excisional surgery and lymphatic etiology was confirmed by histopathology.
Case Discussion
Lymphangiomas are benign lesions of vascular origin that show lymphatic differentiation that contain chylous, serous, hemorrhagic, or mixed fluid and are most often occur in the pediatric population. In 95% of cases, they occur in the neck and axillary regions; the remaining 5% are located in the mesentery, omentum, mesocolon and retroperitoneum following that order, being retroperitoneum less than 1% of cases.
The main differential diagnoses are with cystic lesions such as choledochal cyst, pancreatic pseudocyst, enteric duplication cyst among others. The signal pattern of lymphangiomas on MRI resembles that of fluid: low signal intensity on T1-weighted images and high signal intensity on T2-weighted images
The diagnosis is made by ultrasound, tomography or magnetic resonance imaging. A preliminary study with ultrasound would be useful to demonstrate the cystic nature of the tumor. CT and MRI can help classify the cyst as unilocular or multilocular, establish relationships with neighboring organs, and delineate the boundaries of the lesion.
Complete surgical excision is the treatment of choice to prevent complications such as infection, rupture or bleeding.
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