Clínica de Diagnóstico por Imagem (CDPI) & Instituto Fernandes Figueira (IFF) – FIOCRUZRio de Janeiro – Brazil

Lymphangioma is a benign malformation due to a dilatation of the cystic lymphatics. It can occur in almost any location but are most commonly seen in the soft tissue of the neck, axilla, thorax, and lower extremities. The association with syndromes such as Turner, Fryns, Noonan, fetal alcohol and trisomies 13, 18, 21 can occur. The newborn’s treatment should be in a tertiary-care center. A postnatal MRI should be done to determine the lymphangioma’s extension, which is important for the surgical approach. The sclerosing agent OK-432 can be an alternative treatment.

We report a case of a fetus with a sonographic mid-gestation diagnosis of cystic mass in the neck suspected to be a lymphangioma. The fetal MRI was performed at 28 weeks and repeated in the postnatal period. The prenatal care had no significant problems until the 38th week of gestation, when a cesarian section was done. A male infant weighing 3.100 g with normal karyotype was born.

Axial and coronal view at 24 weeks demonstrating a large complete cystic mass (arrow) in the anterolateral aspect of the fetal neck

Left image: 3D view showing mass in the anterolateral portion of the fetal neck

Right image: Coronal T2 showing the septate mass at 28 weeks

Axial view showing the cervical lymphangioma (arrow)

Note the normal cerebellum (blue arrow)

Sagittal T2 view showing the lymphangioma

Note the normal lungs (blue arrow)

Note the heart (blue arrow)

Axial T1 showing the lymphangioma

T1-weighted showing the lymphangioma protruding from the neck

The newborn before the surgery

The newborn during the surgery and after (Courtesy of Dr. Bruno Aloe)

References

• Garel C, Brisse H, Sebag G, Elmaleh M, Oury JF, Hassan M – Magnetic resonance imaging of the fetus. Pediatr Radiol 28:201-11, 1998.
• Werner H, Daltro P – Ressonância magnética em obstetrícia e Ginecologia. Revinter 2003.