Spontaneous regression of a supraclavicular thoracic duct cyst: case report with a follow-up of 25 years

Abstract

This article is a follow-up of a previously reported case of a thoracic duct cyst. In 1982, a left supraclavicular swelling appeared spontaneously in a 55-year-old man. The mass was located near the lower part of the sternocleidomastoid muscle. Fine-needle puncture yielded chylous fluid. Radiography of the thoracic duct following direct puncture and injection of contrast medium revealed cystic dilatation of the upper part in close proximity to the jugular and subclavicular veins, with widening of the adjacent intrathoracic duct. Surgery was considered but was not performed as the patient had no symptoms. Radiological re-examination in 1991 showed progression in the size of the cystic expansion but, as the patient was still without complaints, no treatment was given. In 1995 (after 13 years), the patient noted that the cyst had diminished spontaneously. Follow-up MR and clinical examination in 2007, 25 years after the first appearance, showed complete regression of both the cervical cystic dilatation and the widened intrathoracic duct. Thus, spontaneous regression of a cystic dilatation of the thoracic duct can occur.

Management of cervical thoracic duct cyst with cyst-venous anastomosis

“…In the review by Brauchle et al only 2 of 15 patients reported in the literature were treated with observation. A follow up report on one of these patients 25 years later showed spontaneous regression of the cyst with conservative management, 10 suggesting that observation is a reasonable option. The psychological angst associated with a mass of unknown origin may be a contributing factor to the generalized practice of surgical resection, but other benefits of excision include definitive histologic exclusion of malignancy and potential relief of symptoms.…”

Variations in the Management of Cervical Thoracic Duct Cyst

“…Conservative management includes observation alone, dietary changes of limiting fat intake to medium-chain fatty acids, and external compression. Several asymptomatic patients opted for observation, as they have been reassured following diagnostic procedures [3, 11, 21, 22]. Zätterström et al [22] reported a case of spontaneous regression treated with observation alone as the patient was generally asymptomatic apart from the painless left supraclavicular mass.…”

Lymphovenous anastomosis for recurrent swelling syndrome and chylous effusion due to cervical thoracic duct cyst

“…Complete regression has been reported. 3,11 If there are complaints, the medical treatment includes a low-fat diet with medium-chain triglyceride restriction and sometimes repeated percutaneous aspiration. 8,12 Surgery is considered if there is recurrence with clinical symptoms and consists of excision of the cervical cyst.…”