Management of Isolated Fetal Lymphangiomas Following Prenatal Diagnosis: Case Series

Abstract

Lymphangiomas are benign cystic lesions caused by the failure of lymphatics to communicate with the lymphatic-venous drainage system. They have an incidence at birth of about 1 in 6000 and can occur at almost any location, most commonly the soft-tissues of the neck. Prenatal diagnosis is by ultrasound, where they appear as cystic masses of variable size, often with septations inside and absent flow on color doppler. Antenatal management involves serial monitoring of the fetus by ultrasound with attention to possible pressure effects and airway obstruction depending upon the size and location of the lymphangioma. The mode of delivery must be decided based on the possibility of obstructive labor or the need for resuscitation. Rarely, a large mass over the anterior neck causing airway obstruction may need an EXIT procedure.Large cystic hygromas need surgical excision while small to medium size lesions can be managed by conservative measures including sclerotherapy. We report three cases of isolated fetal cystic hygromas diagnosed prenatally at various gestations. Two were of moderate size over the anterolateral aspect of the neck and one case had a huge lymphangioma involving the entire right side of the chest wall.