Case#22

 
12 year old male patient with a progressive enlargement in the submandibular area, slightly right of the midline. The lesion reportedly becomes more prominent occasionally and barely noticeable in some days. The patient describes some discomfort in the area. 

  

Physical examination revealed a soft tissue prominence in the area, soft to palpation, not sensitive to touch, easily compressible. No thrill is noted over the lesion to suggest a high flow anomaly. There are no skin changes over or near the lesion.  MRI examination (not shown here) revealed a large cyst like signal abnormality in the area. The clinical findings, history and imaging findings all consistent with a macrocystic lymphatic malformation (commonly called "cystic hygroma"). 

If the lesion is asymptomatic entirely, a treatment may not be needed. If treatment is needed, a surgical intervention is commonly used. However, sclerotherapy is a leading alternative to surgery in this condition, which is less invasive and demonstrates similar success rates. There are several different sclerosant agents available for lymphatic malformation. In the U.S.A., the most commonly used sclerosant agents probably alcohol, sotrecol, ethamolin (????) or doxycycline.

In this patient, sclerotherapy is selected for therapy and doxcycline was selected as a sclerosant agent. The lesion becomes less noticeable after the therapy (not shown here). No surgical intervention was needed. 

     
The first image a contrast injection into the lesion using a small needle under ultrasound and fluoroscopy guidance. This is done to assess the lesion before sclerotherapy. The fluid content of the lesion is then aspirated as much as possible using negative pressure (second image - photo). Subsequently, sclerosant agent is mixed with contrast material appropriately and injected into the lesion slowly, again using fluoroscopy guidance (last image).   

 

                                                                            

 

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