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MEDIASTINAL
LYMPHANGIOMA |
·
Mediastinal
lymphangioma (cystic hygroma) is a histologically benign (1) proliferation of
interconnecting lymphatic vessels and sacs that may grow in an infiltrative
fashion (2).
·
Etiology is
controversial; some authors suggest it is a developmental lesion (2) while
others postulate it has a hamartomatous or neoplastic origin (1,2).
·
Lymphangioma
is typically a tumor of very young children.
o
Fifty
percent are present at birth and 90% are discovered by 2 years of age (1,2).
o
Ninety-five
percent involve the neck or axilla.
o
10% extend
into the superior aspect of the anterior mediastinum (2) or, less commonly, other mediastinal compartments (1).
·
Pathologically,
the dilated lymph spaces can range in caliber from capillary size to several
centimeters in dimension (2).
ULTRASOUND / CT
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o
Mediastinal
lymphangioma typically occurs in the superior aspect of the anterior
mediastinum and is usually contiguous with a cervical or axillary component (3).
o
Radiologically,
these are rounded, lobulated, multicystic tumors that can reach massive sizes
and may infiltrate across tissue planes.
o
They may
surround or displace mediastinal structures (1-4).
o
On CT,
"cysts" (representing the large vascular spaces) vary in diameter
from 1 to 2 mm to several centimeters, are usually near
water attenuation, and display thin or thick septa that may enhance minimally
after contrast administration (2,3).
o May lead to chylous pleural effusion and lytic lesion in adjacent bones.
REFERENCES
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1.
Bill AH Jr, Sumner DS. A unified concept of lymphangioma and
cystic hygroma. Surg Gynecol Obstet 1965;120:79-86.
2.
Scalzetti EM, Heitzman ER, Groskin SA, et al. Development
lymphatic disorders of the thorax. Radiographics 1991;11:1069-85.
3.
Brown LR, Reiman HM, Rosenow EC, et al. Intrathoracic
lymphangioma. Mayo Clin Proc 1986;61:882-92.
4.
Shaffer K, Rosado de Christenson ML, Patz EF, et al.
Thoracic lymphangioma in adults: CT and MR imaging features. AJR Am J
Roentgenol 1994; 162:283-89.
5.
Pilla TJ, Wolverson MK, Sundaram M, et al. CT evaluation of
cystic lymphangiomas of the mediastinum. Radiology 1982;144:841-42.
6. Bashist B, Ellis K, Gold RP. Computed tomography of intrathoracic goiters. AJR Am J Roentgenol 1983;140:455-60.