Giant Cystic Hygroma with Complete Encasement of the Great Vessels of the Neck in an 18 Month Old Infant

Abstract

Background

Cystic hygroma is a benign condition of the lymphatic vessels. It is seen in 1 in 5000 live births. Generally lymphatic malformations are classified into microcystic and macrocystic. They commonly occur in the cervicofacial and axillary regions.

The Case

A 1 year and 6 month old female child presenting with progressive right side neck swellings with later development of voice change and air hunger which is positional. Contrast enhanced CT of the neck demonstrated cystic mass with encasement of the common carotid artery and jugular vein with the mass also extending to the submandibular gland and the base of skull. After a 48 hour course of dexamethasone the patient was operated on with complete excision of the mass. Intraoperatively we also encountered right hypoglossal nerve passing through the mid part of the mass. Patient developed post-operative facial palsy with progressive improvement.

Conclusion

Giant lymphatic malformations particularly in the neck region can involve great vessels and major nerves so extreme care is needed during operative interventions to avoid major operative injuries.

Keywords:

• giant cystic hygroma
• common carotid artery
• vagus nerve
• hypoglossal nerve

Abbreviation

LMs refers to lymphatic malformations.

Ethics Informed Consent

Informed consent was obtained from the guardians of the patient to publish the case and use of both preoperative and intraoperative images. Institutional approval is not acquired to publish this report.

Acknowledgment

To the families of the girl for their willingness for the case to be reported and to Dr. Fisseha Temesegen (consultant General and Pediatric surgeon at Tikur Anbessa Specialized University Hospital, Addis Abeba University) for the valuable advice that he has given us during the surgical planning.

Disclosure

The authors report there is no known competing financial interest or personal relationships that could have appeared to influence the work reported in this paper.

Additional information

Funding

No support or funding was obtained for this report.