Clinical Spotlight
Anterior Mediastinal Lymphangioma in an Infant: Diagnosis and Surgical Management

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Cystic lymphangioma is a rare lesion of the mediastinum. We present a patient with an antenatally detected mediastinal mass that appeared to regress during foetal life and was not demonstrated on early postnatal imaging. Acute severe respiratory distress at two months of age precipitated surgery with subsequent diagnosis of lymphangioma.

Introduction

Cystic lymphangiomas, also known as cystic hygromas, are malformations of lymphatic vessels occurring commonly in the neck and axillae, rarely in other locations including the mediastinum [1]. While the exact incidence is unknown, mediastinal lymphangiomas are reported to represent between 0.01 and 4.5% of mediastinal tumours [2]. They are infrequently described in infants, and less than 2% of lymphangiomas described in childhood are mediastinal in location [3]. We report a case of an anterior mediastinal cystic lymphangioma in a two-month old infant.

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Case Report

A multi-gravida woman attended usual antenatal care. Foetal ultrasound was normal at eight weeks gestation, but at 20 weeks gestation revealed a 1.5 cm × 1.4 cm × 2.2 cm solid and cystic mass adjacent to the right atrium and extending cranially. A small pericardial effusion surrounded a structurally normal heart. Differential diagnoses for the lesion included cystic teratoma, lymphangioma, pericardial cyst, thymic cyst, bronchogenic cyst and cystic thymoma [1], [2]. Comprising solid and cystic

Discussion

Lymphangiomas can be detected antenatally, appearing as a cystic mass that may enlarge on follow-up [4], [5]. A mediastinal mass was identified in our patient at 20 weeks gestation which regressed and was not demonstrated by late antenatal or early postnatal ultrasounds. Although the most likely diagnosis at the time of initial antenatal ultrasound was teratoma, this was revised as spontaneous regression of fetal intra-thoracic tumours is most commonly seen with simple pericardial cysts [4], [5]

Comment

Cystic lymphangioma is a rare benign lesion of the mediastinum in children. Removal of all abnormal tissue should be performed to avoid recurrence of the lesion or persistent lymphatic drainage. Close follow-up of children with an antenatally suspected lesion should be performed as rapid increase in size may lead to an emergent presentation.

Acknowledgements

The authors have no financial or other conflicts of interest to declare. No financial support was received in the preparation of this manuscript.

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