Giant cervical lymphangioma encompassing the neck great vessels (carotid artery and jugular vein): a case report

Abstract

Introduction and importance: Lymphangiomas are benign congenital defects affecting the lymphatic system. These lesions commonly involve the head and neck, predominantly the posterior cervical triangle. Lymphangiomas cause obstructive symptoms in the upper airway and pose an esthetic concern to the patient. Clinically, these lesions are seen as cervical swelling, and a definite diagnosis is made by ultrasonography, computerized tomography scanning, and histopathologic analysis. Herein, the author present an unusual case of an 18-month-old child presenting with a huge cervical swelling on the right side with extension to the carotid triangle (encompassing neck great vessels) as well as unilateral neck and fascial disfigurement. The patient was treated surgically with the complete excision of the mass and followed up with an excellent esthetic result. Case presentation: An 18-month-old child was brought to our teaching hospital’s pediatric surgery department with a huge cervical mass on the right side since birth. Following the completion of work-up with the laboratory and imaging (computerized tomography scan) diagnostic modalities, the patient was prepared for definite treatment. Our team approached the mass through a right neck hockey stick incision, and with the preservation of the neurovascular bundle, the mass was completely excised. The patient was followed up for 12 months on two occasions, with excellent esthetic results and no relapse. Conclusion: Lymphangiomas confined to the posterior cervical triangle are a common problem in children. Lesions extending to the anterior of the neck, especially those involving the neck neurovascular bundle, are uncommon entities. The decision to proceed with sclerotherapy or surgical excision should be justified, provided that, during the surgical procedure, the neurovascular bundle is preserved and none of the vital organs (neurovascular components) are compensated with the goal of a complete mass excision.