Clinical Example of Non-Informative Complex Radiological Examination in Case of Lymphangioma of the Peroneal Nerve

Abstract

urpose. To demonstrate the limitations of modern methods of complex radiology diagnostics in case of rare localization of lymphangioma using the example of a clinical case. Material and methods. The stages of clinical, radiological and laboratory examinations in the diagnosis of peroneal nerve lymphangioma were analyzed according to the history of a 47-year-old patient.Results. During the examination of the patient, changes in the peroneal nerve were revealed: ultrasound examination revealed structural changes; on MRI examination -cystic transformation of the peroneal nerve, atrophic changes in the long peroneal muscle, in the long extensor of the fingers and in the anterior tibial muscle; with electroneuromyography -gross axonal motor and sensory neuropathy of the right peroneal nerve. In a specialized institution, the patient underwent surgical treatment in the amount of microsurgical removal of the tumor of the right peroneal nerve upper third with one-stage autoplasty of N. suralis. According to the results of histological examination of the removed mass, peroneal nerve lymphangioma was diagnosed. At the follow-up examination (3 months after the operation), there were no data for tumor recurrence; according to ENMG, signs of gross axonal motor and sensory neuropathy of the right peroneal nerve were preserved.Discussion. The uniqueness of the case is due to the discrepancy between the avascular picture of the neoplasm revealed by color Doppler mapping and the traditional characteristics of lymphangiomas.Conclusions. The complexity of diagnosing and verifying lymphangioma of the peroneal nerve requires the use of complex research methods and a mandatory assessment of the results of surgical treatment in dynamics. MRI diagnostics can be recommended as the most informative method for detecting this pathology. In a number of clinical cases, the possibilities of modern complex radiology diagnostics in lymphangiomas of atypical localization are limited. In such situations, the final diagnosis can be established only after biopsy and histochemical examination of the intraoperative material..