Cystic lymphangioma of the axilla and chest wall

Abstract

Fetal cystic lymphangiomas are benign tumors arising from the lymph vessels. They have been demonstrated in a number of different anatomic locations, including the nuchal region, axilla, mediastinum, chest wall, retroperitoneal area, abdominal viscera, groin and pelvis. The defect is most often found in the nuchal region. In these cases, the etiology is related to inadequate drainage of the lymphatic vessel into the venous system. Nuchal lymphangiomas are often associated with chromosome abnormalities. Cystic lymphangiomas at other locations are thought to have a distinct etiology, most likely as a result of insufficient anastomoses with larger lymphatic channels. The association with chromosome anomalies in these cases is less distinct. We describe 2D and 3D ultrasound findings associated with the prenatal finding of cystic lymphangioma in two patients. The first patient is a 29-year-old G4P2 female referred for an ultrasound due to marginal sinus bleeding. A follow-up scan at 23 weeks identified a multiloculated cystic mass measuring 7.2 × 6.8cm in its largest dimensions. The patient was followed at 3-week intervals with 2D and 3D imaging performed at each visit. At the time of delivery, the mass measured 8.2×7.9cm. Surgical excision was performed on day 2. The second patient is a 23-year-old G1P0 female referred at 35 wks for an ultrasound secondary to the finding of a multiloculated mass on the right chest wall, 4 cm below the axilla. The mass measured 2×3cm. The right arm appeared to move freely. Both 2D and 3D imaging were performed. At birth, the mass measured 1×1 cm. Surgical excision has not been performed. Medical management is currently observational. Both patients were offered an amniocentesis. Neither patient opted for this procedure. Additional birth defects or genetic anomalies were not detected in either patient. The 3D ultrasound allowed for a unique imaging opportunity of a rare congenital malformation.