CASE REPORT © 2013 SNL All rights reserved

A case of cystic hygroma of the chest

This report describes the case of a male infant who presented with a mass on the chest wall. The mass was soft, non-tender and transilluminating. An scan revealed a multiseptate, thin-walled cystic mass, consistent with a diagnosis of cystic hygroma.

Raj Lodh baby of 37 weeks’ gestation was born MBChB, BMedSci Aby normal delivery to a primigravida ST8 Paediatric Neurodisability, Great North mother with no significant medical history. Children’s Hospital, Newcastle upon Tyne The antenatal screening had revealed no [email protected] abnormalities. On delivery he was noted to have a cystic mass on the left lateral chest Nakul Gupta wall measuring 9x9x6cm (FIGURE 1). The MBChB mass was noted to be soft, non-tender and ST6 Paediatrics, Addenbrooke’s Hospital, transilluminating (FIGURE 2). There was Cambridge no bruit heard on auscultation. The rest of the physical examination was normal. FIGURE 2 Transillumination can help to Ultrasound showed a multiseptate, thin- differentiate cystic hygromas from other walled cystic mass, consistent with a diag- types of solid mass. nosis of cystic hygroma. Chromosomal normal connections between venous and karyotyping revealed a normal 46XY lymphatic drainage1. The Greek word appearance. hygroma means ‘moist tumour’. The The child went on to have uncomp- majority are congenital, being evident at licated surgical removal of the mass at one birth (50-65%) or within the first two year of age. years of life (90%)2, however rare adult- Discussion onset cases have been described in the literature3. Cystic hygromas (also known as cystic The incidence of congenital cystic ) are benign, painless hygroma is said to be 1/6000 live births4. loculated lymphatic proliferations, which Hygromas diagnosed on antenatal scan occur due to lack of development of the have historically been associated with Keywords poorer prognosis (usually due to develop- ment of hydrops), although a recent study cystic hygroma; cystic ; suggested that up 42% of these may resolve dysmorphism spontaneously by birth5. A significant Key points proportion of patients will have a chromosomal disorder, with up to 60% Lodh R., Gupta N. A case of cystic hygroma having a diagnosis of Turner syndrome6. of the chest. Infant 2013; 9(4): 130-31. Cystic hygromas may theoretically 1. Cystic hygroma is a relatively benign condition that can cause considerable develop at any site during embryonic anxiety to parents and professionals, lymphatic development, however the most especially where antenatal scans have common sites include the posterior been reported as normal. (75%) and axilla (20%)7. Less frequently 2. Examination and ultrasound findings reported areas include the mediastinum, are characteristic and should lead to a retroperitoneum, abdominal viscera, groin, prompt diagnosis and appropriate bones and scrotum7. management. Complications of cystic hygromas 3. Thought should be given to a possible include bleeding into the , infections underlying chromosomal disorder and (usually due to seeding from respiratory or any potential complications that may other infections) and abscess formation. In arise due to the site and size of the FIGURE 1 A cystic mass on the left lateral these situations, transillumination may be mass. chest wall. lost and the hygroma will become tense

130 VOLUME 9 ISSUE 4 2013 infant CASE REPORT and often tender8. Mechanical obstruction References (EMSYCAR) 2000-2009. Arch Dis Child Fetal Neonatal Ed 2011;96:Fa73-Fa74. of the airway and dysphagia may occur for 1. Kane K.S., Ryder J., Johnson R. et al. Colour Atlas and 6. Alpman A., Cogulu O., Akgul M. et al. Prenatally those sited in the neck4,8. Synopsis of Paediatric . 1st ed. McGraw- diagnosed and cystic hygroma: Surgical excision remains the mainstay Hill Professional;2002.p212. incidence and reasons for referrals. Fetal Diagn Ther 2. McIntosh N., Helms P.J., Smyth R.L. Forfar and of treatment for cystic hygromas. 2008;25:58-61. Arneil’s Textbook of Paediatrics. 6th ed. Churchill is electively conducted (with CT scan or Singh S., Baboo M.L., Pathak L.C. Livingstone; 2003. 7. Cystic MRI), except if life-threatening comp- 3. Sherman B.E., Kendall K. A unique case of the rapid lymphangioma in children: report of 32 cases inc- lications are present. It is not without risk onset of a large cystic hygroma in the adult. Am J luding lesions at rare sites. Surgery 1971;69:947-51. as nerves, arteries, veins and pleura (dep- Otolaryngol 2001;22:206-10. 8. Mirza B., Ijaz L., Saleem M. et al. Cystic hygroma: an ending on site) are often found in close 4. Sannoh S., Quezada E., Merer D. et al. Cystic overview. J Cutan Aesthet Surg 2010;3:139-44. proximity. Recurrences can occur despite hygroma and potential airway obstruction in a 9. Manikoth P., Mangalore G.P., Megha V. Axillary cystic hygroma. J Postgrad Med 2004;50:215-16. presumed total excision. Alternatives to newborn: a case report and review of the literature. Cases J 2009;2:48. 10. Bozkaca S., Ug˘ar D., Karaca I. et al. The treatment of surgery include injecting sclerosing agents, 5. Budd J.L., Craft E., Draper E.S. Outcomes following lymphangioma in the buccal mucosa by radio- such as bleomycin, directly into the mass prenatal diagnosis of cystic hygroma: East Midlands frequency ablation: a case report. Oral Surg Oral and the use of laser therapy9,10. & South Yorkshire Congenital Anomalies Register Med Oral Pathol Oral Radiol Endod 2006;102: 28-31.

Check out the Infant website at www.infantgrapevine.co.uk

For all the latest jobs, conferences and articles

Full text of all the articles published in Infant during 2005-2010 is accessible free-of-charge on the website. For more recent articles, abstracts are freely available and access to the full text can be purchased online.

You’ll find a comprehensive listing of neonatal and paediatric conferences on the website. If you’ve got a conference or study day to publicise you can add brief details online free-of-charge. Email us the details at [email protected] as well for them to be included in the printed version – space APRIL 2013 permitting. infant grapevine Search our jobs page for up-to-date advertisements of neonatal Baby Friendly Initiative Training Courses Developing a Nurturing Environment for Train the Trainer Neonatal Care y 13

24-26 July 13 a A study day for those working in neonatal care.

hout 13 Cost: £695 Topics include: g • Nutrition care pathway

Breastfeeding and Relationship Building 23 M • Supporting the preterm infant in establishing feeding 25-26 April 13 • Pseudomonas in the neonatal unit and paediatric vacancies and sign up for a free copy of Throu Cost: £395 • Building a developmental environment Venue: London • The neurodevelopment of the preterm infant Further information on each course and how to book: Venue: Hilton Bath City Hotel, Bath http://www.unicef.org.uk/BabyFriendly/Health- Cost: £55 Professionals/Training/ Contact: [email protected] Grapevine to be sent to you every two months. Email www.ruh.nhs.uk/nicu Foundation Toolkit in Developmental Care Organised by Inspiration Healthcare and Sheffield Teaching SNNG Annual Conference Hospitals, the course is relevant for all healthcare Scottish Neonatal Nurses Group annual conference and professionals working with preterm and newborn infants. y 13 a exhibition. Topics include: Venue: The Endcliffe Village, Sheffield • Tissue viability [email protected] with your address and contact Cost: £200 •Neonatal patient safety 31 M • Use of high flow in transport 29-30 April 13 Contact: [email protected] •Management of gender anomalies Understanding Newborn Behaviour and Supporting • Role of the family nurse partnership Early Parent-Infant Relationships • Bliss nurses and support worker roles y 13 Venue: Crowne Plaza Hotel, Glasgow details. a Training course organised by The Brazelton Centre Newborn Behavioural Observations (NBO) Cost: £75 (SNNG members £65) Venue: The Royal Society of , London Contact: Tel: 01412 012756 [email protected]

9-10 M Cost: £685 www.snng.org.uk Contact: [email protected] Tel: 01223 314429 Annual Middlesbrough Neonatal Conference and www.brazelton.co.uk Ventilatory Workshop Neonatal and Paediatric Ventilation An important annual event attracting neonatologists, paediatricians and neonatal nurses. This course combines lectures with practical workshop y 13 Venue: Durham University, Teesside

a sessions. 6-8 June 13 Venue: Institute of Child Health, London Cost: £180-£480 Finally – your feedback is always welcome. Cost: Nurses £329, Doctors £499 Contact: Tel: 01642 282534 [email protected] Contact: Tel: 0207 905 2699

16-17 M www.neonatalconference.co.uk [email protected] www.ucl.ac.uk/ich/education-ich/events Reason Conference What Next? Dreams for the Future Annual conference for neonatal nurses and doctors. The fifth Annual National Neonatal Conference for clinical Platinum Sponsors: Chiesi and Fisher & Paykel Healthcare. Email us on [email protected] y 13 Venue: University of Warwick, Coventry a matrons and their senior nursing team. Venue: Tortworth Court, Four Pillars Hotel, Bristol Cost: Nurses £305, Doctors £415 1-2 July 13 Contact: Su Monk Contact: CFS Events Ltd Tel: 01173 236325 Tel: 0800 9177 405

16-17 M [email protected] www.cfsevents.co.uk

infant VOLUME 9 ISSUE 4 2013 131