A rare case of mediastinal lymphatic venous malformations in children

Abstract

We report a case of mediastinal lymphatic venous malformations (LVM) in a 11‐year‐old boy who presented with chest pain after jumping into a swimming pool, with review of the literature. A superior mediastinal mass was incidentally found from the chest x‐ray. Chest computed tomography revealed a large heterogenous mass at the left‐sided mediastinum containing fat, minimal enhancing solid portion, non‐enhancing cystic portion and calcification. Because of the large size of the mass, the patient underwent tumour removal. Operative findings gave a definitive diagnosis of mediastinal LVM. The patient had an uneventful clinical course and was discharged without complication. This report highlights that it is possible to misdiagnose mediastinal LVM especially if its predominant portion is lymphatic tissue with only minimal contrast enhancement. Tissue biopsy must be avoided because it may lead to haemorrhagic complication.

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“…LVMs, slow-flow vascular malformations are one of the combined types, which are defined as two or more vascular malformations found in one lesion 2 LVMs are usually found in the cervical, axillary, head, and neck region 3 . LVM in the mediastinum is a rare occurrence and only account for 0.5% of mediastinal tumours 4 .…”

“…Radiological findings in computed tomography (CT) and magnetic resonance imaging (MRI) of LMV depend on the proportions of the lymphatic and venous components 3 4 . MRI is useful for the diagnosis of mediastinal LVM as it can effectively detect slow-flow components and small vessels such as venous connections to the superior vena cava 3 . MRI for our patient was not done due to financial constraints.…”

“…LVMs are tumour-like lesions combining dysplastic lymphatic and blood vessel structures 2 . Pathogenesis of LVM is unknown 3 . Clinical manifestations of mediastinal LVMs vary depending on size, location, expansion of mass and the proportion of lymphatic and venous components 3 .…”

“…Pathogenesis of LVM is unknown 3 . Clinical manifestations of mediastinal LVMs vary depending on size, location, expansion of mass and the proportion of lymphatic and venous components 3 . LVMs are rare and to our knowledge, there are no case reports of infants in English medical literature.…”

“…An ultrasound scan of the chest revealed a well-defined multi-loculated cystic lesion measuring 3.5×4.6×5.4cm in size in the anterior mediastinum at the level of ascending aorta in the right paracardiac location suggestive of an infected bronchogenic cyst. ________________________________________________ 1 Senior Registrar in Paediatrics, University Paediatric Unit (UPU), Teaching Hospital Karapitiya (THK), Sri Lanka, Sri Lanka, 3 Registrar in Paediatrics, UPU, THK, Sri Lanka, 4 Medical Officer in Paediatric Surgery, THK, Sri Lanka, 5 Registrar in Histopathology, THK, Sri Lanka, 6 The fever continued despite treatment. On day 4 of illness a contrast-enhanced computed tomography (CECT) scan of chest (Figure 2) revealed a multiloculated cystic lesion in the anterior mediastinum measuring 3.8 (AP) ×4.2 (Tr) ×4.6 (cc) cm.…”