Fetal Mediastinal Lymphangiomas

Abstract

Objective. The purpose of this series was to evaluate the prenatal sonographic findings and postnatal outcomes in 2 fetuses with mediastinal lymphangiomas. Methods. The fetal images were compared with postnatal imaging and surgical findings. Results. The 2 fetuses had anechoic mediastinal masses at 25 and 22 weeks, which proved to be lymphangiomas. One, located in the anterior mediastinum, also enveloped the superior vena cava, brachial plexus, phrenic nerve, larynx, and lower parts of the neck vessels and extended into the subcutaneous tissues of the anterior chest wall through an intercostal space. In the second patient, the lymphangioma appeared to be a unilocular cyst, which involved the deep tissues of the neck as well as the posterior and lateral mediastinum. Both required 2 interventions after birth. Conclusions. Fetal mediastinal lymphangiomas appeared anechoic and sent extensions into the neck in the first case, around the superior vena cava, through the intercostal spaces to the skin, and around the brachial plexus in the second case, and deviated the trachea in both cases. In 1 case, there was also ectasia of the superior vena cava. This ability to entwine around vital structures can make it difficult to determine the extent of involvement on antenatal sonography and to remove lymphangiomas completely, and recurrence is common. Key words: fetal cystic hygroma; lymphangioma; mediastinum; neck; skin; superior vena cava.Received August 13, 2007, etal lymphangiomas of the chest are rare occurrences. The purpose of this series was to evaluate the prenatal sonographic findings and postnatal outcomes in 2 fetuses with mediastinal lymphangiomas. Case DescriptionsCase 1 A 22-year-old patient, gravida 3, para 2, was seen for sonographic examination at 25 weeks' gestation. A cystic mass measuring 3.3 × 0.7 cm with some small septations was located between the heart apex and left chest wall (Figure 1) and extended up around the base of the superior vena cava (SVC). The SVC appeared dilated and irregular, but no obstruction could be identified (Figure 2). No flow was seen within the cystic mass, and although there were multiple septations, there were no solid components. The differential diagnosis included a

Prenatally diagnosed large mediastinal lymphangioma: A case report

“…In our case, the lesion occupied more than half of the bilateral thoracic cavities and was the largest lesion reported in the literature. Any mass in the thoracic cavity in a fetus requires precise evaluation with fetal ultrasonography and MRI, and its differential diagnoses, other than lymphangioma, include congenital diaphragmatic hernia, teratoma, thymoma, pulmonary sequestration, and bronchogenic and neurogenic cyst . In our case, fetal MRI showed a large mediastinal cyst without a solid component, but did not visualize the septum, which could only be detected by ultrasonography.…”

“…Our literature search revealed only 13 pediatric cases with prenatally diagnosed lymphangioma that were mainly confined to the mediastinum. [1][2][3][4][5][6][7] The clinical features of the 14 cases, including ours, are presented in Table 1. The lesions in those cases were first detected in 20-35 weeks of gestational age.…”

Isolated Mediastinal Lymphangioma: Prenatal Diagnosis and Thoracoscopic Treatment

“…Th ey constitute about 3% of all mediastinal masses in children [2]. A pre natal diagnosis has already been reporte d in 8 cases for a n i solated ML [3][4][5][6][7][8][9][10]. It m ay be s uspected when t he sonographic examination shows a si ngle or multilocated paracardiac an terior m ediastinal cystic mass.…”

“…Our c hild was 7 m onths o ld w hen t he t horacoscopic treatment was pe rformed. Nevertheless, postoperative complications can a rise afte r th e treatm ent of ML; th e surgical resect ion m ay be incom plete because of a dhesions with t he great ve ssels or pericardium and rec urrences are po ssible [1,5,9,21]; a few p atients d isplayed temporary or definitive phren ic nerve palsy o r Horn er's syndrome as well [1 ,21,22]. In our case, a com plete resection was p erformed an d the p hrenic ne rve was see n during the entire p rocedure, w ithout po stoperative complication.…”

“…Among the 4 last cases, 3 fetal hydrops occurred with 1 neonatal death [3], 1 prematurity at 35 weeks' gestation [7] an d t he t hird u nderwent dr ainage of t he cyst at 24 weeks with success [5]. T he ML may be as sociated with a cervical cyst [9,14] and s ometimes with an abdominal extension [15]. A termination of the pregnancy was performed for one fetus pre sented a cervico-mediastinoretroperitoneal lymphangioma [11].…”