Cystic hygroma is a lymphatic malformation which usually presents in infancy and childhood.When diagnosed by prenatal ultrasound , it is usually associated with chromosomal anomalies. Although an occasional infant may present with respiratory distress, the major problem is the cosmetic disfigurement they produce. Recurrence following surgical excision is not rare. Here,we present one such case.
Key Words: Lymphatic malformation, Cystic hygroma
Miss S is a seventeen year old girl who was referred to us with the complaint of a swelling in the right side of her neck for the past six months. She gave a history of previous surgery six years back. After temporary regression, it gradually increased to its present size.
On examination, a scar of previous surgery was present.
There is a diffuse swelling 20 L 15 cm’s ,occupying the posterior triangle of the neck extending to the submandibular and parotid regions, which was smooth, fluctuant, non transilluminant, adherent to to the skin and deep to the sternocleidomastoid.
A provisional diagnosis of cystic hygroma was made and a CT Scan obtained to exclude mediastinal extension.
CT Scan: Large ,non enhancing,fluid density cystic mass occupying the entire posterior triangle,extending down to just beneath the right clavicle.No extension of the lesion into the mediastinum or axilla. Consistent with recurrent cervical cystic hygroma. (Fig.2)
After pre-operative workup, she was taken up for surgery
A large, multiloculated ,cystic lesion containing haemorrhagic fluid was identified deep to the right sternocleidomastoid extending up to the parotid region superiorly and the right clavicle inferiorly. Excision was done in entire after dividing the muscle.Haemostasis attained. Suction drain placed after suturing the muscle. (Figs.4R9)
Her post-operative period was uneventful and she was discharged on the tenth day.