Mediastinal lymphangioma in adults: CT and MR imaging features

Abstract

Adult mediastinal lymphangiomas are rare lesions the diagnosis of which is difficult based on imaging studies. A retrospective study of CT, MR, and pathologic findings of mediastinal lymphangioma was performed in order to correlate pathological and imaging findings. Nine cases of adult lymphangiomas were identified in the records of our institution over a 12-year period. The CT, MR, and pathologic findings were reviewed. Lesions were classified pathologically as unilocular, cavernous, and intermediate types. Pathologic examination identified six cases of unilocular lesion, two cases of cavernous type, and one intermediate type. The CT features (n = 9) included a smoothly marginated non-enhancing mass of water attenuation (n = 7), a non-enhancing mass of soft tissue attenuation (n = 1), and an enhancing multiseptated mass (n = 1). Lesions were located in the anterior mediastinum (n = 2), right paratracheal (n = 4), subcarinal (n = 1), aortopulmonic window (n = 1) areas, and below the left hilum extending into the posterior mediastinum (n = 1). The MR features (n = 3) were characterized by an enhancing multicystic and multiseptated appearance, evocative of a cavernous type in two cases. The CT appearance of mediastinal thoracic lymphangioma is variable depending on the pathologic type. The most common unilocular type is a non-enhancing thin-walled mass on CT. A less frequent cavernous type can be suggested based on a multiseptated and loculated mass on CT and/or MR examination.

Simultaneous hemopericardium, hemoperitoneum and hemothorax after complete surgical resection of mediastinal cystic lymphangioma: A case report

“…Imaging techniques such as computed tomography (CT) scan and magnetic resonance imaging (MRI) scan may be used to make a clinical diagnosis and for followup. They respectively show homogeneous low density and T2 hyperintensity [12]. The latter was not confirmed in our case with only low hyperintensity in T2.…”

“…Lymphangiomas can affect all compartments, but anterior and superior mediastinum are those most commonly affected as in our case. Some unusual sites described are the hilum, pericardium, axilla, shoulder joint, retroocular region, esophagus and chest [12]. Imaging techniques such as computed tomography (CT) scan and magnetic resonance imaging (MRI) scan may be used to make a clinical diagnosis and for followup.…”

“…On CT scan and/or MRI scan, a cystic lymphangioma can be suggested based on multiseptated and loculated mass [12]. The gold standard treatment of lymphangioma is complete surgical resection [1,2,13].…”

Pleuroperitoneal Shunt for Refractory Chylothorax Accompanied with a Mediastinal Lymphangioma: A Case Report

“…Common descriptions on CT include well circumscribed cystic mass with compression or deviation of the trachea, superior vena cava, etc. 3,4) Contrast enhancement, visualized of septa or calcification is rare. Typical MR appearance is cystic component with the multilocular septums with low signal intensity on T1W1 and high signal intensity on T2W1 and focal inhomogeneities.…”

“…Typical MR appearance is cystic component with the multilocular septums with low signal intensity on T1W1 and high signal intensity on T2W1 and focal inhomogeneities. 4) Standard treatment for mediastinal lymphangioma is surgical excision. 3,5) Nanson 5) advocated immediate surgical excision because of the potential for this entity to grow and thereby complicate future interventions.…”