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Challenges in the prenatal and post-natal diagnosis of mediastinal cystic hygroma: a case report

INTRODUCTION: Cystic hygroma is a benign congenital neoplasm that mostly presents as a soft-tissue mass in the posterior triangle of the neck. Pure mediastinal lesions are uncommon; the vast majority are asymptomatic and are an incidental finding in adulthood. The diagnosis is often made intra- or p...

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Autores principales: Nazir, Sarfraz Ahmed, Raza, Syed Arsalan, Nazir, Sheraz, Sherwood, William, Bowker, Colene, Lakhoo, Kokila
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2008
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518156/
https://www.ncbi.nlm.nih.gov/pubmed/18673546
http://dx.doi.org/10.1186/1752-1947-2-256
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author Nazir, Sarfraz Ahmed
Raza, Syed Arsalan
Nazir, Sheraz
Sherwood, William
Bowker, Colene
Lakhoo, Kokila
author_facet Nazir, Sarfraz Ahmed
Raza, Syed Arsalan
Nazir, Sheraz
Sherwood, William
Bowker, Colene
Lakhoo, Kokila
author_sort Nazir, Sarfraz Ahmed
collection PubMed
description INTRODUCTION: Cystic hygroma is a benign congenital neoplasm that mostly presents as a soft-tissue mass in the posterior triangle of the neck. Pure mediastinal lesions are uncommon; the vast majority are asymptomatic and are an incidental finding in adulthood. The diagnosis is often made intra- or postoperatively. Prenatal identification is exceptional and post-natal diagnosis also proves challenging. CASE PRESENTATION: We report one such case that was mistaken for other entities in both the prenatal and immediate post-natal period. Initial and follow-up antenatal ultrasound scans demonstrated a multicystic lesion in the left chest, and the mother was counselled about the possibility of her baby having a congenital diaphragmatic hernia. Initial post-natal chest radiographs were reported as normal. An echocardiogram and thoracic computed tomography scan confirmed a complex multiloculated cystic mediastinal mass. The working diagnoses were of a mediastinal teratoma or congenital cystic adenomatous malformation. At operation, the lesion was compressed by the left lung and was found to be close to the left phrenic nerve, which was carefully identified and preserved. After excision, histopathological examination of the mass confirmed the diagnosis of cystic hygroma. Postoperative dyspnoea was observed secondary to paradoxical movement of the left hemidiaphragm and probable left phrenic neuropraxia. This settled conservatively with excellent recovery. CONCLUSION: Despite the fact that isolated intrathoracic cystic hygroma is a rare entity, it needs to be considered in the differential diagnosis of foetal and neonatal mediastinal masses, particularly for juxtadiaphragmatic lesions. The phrenic nerve is not identifiable on prenatal ultrasound imaging, and it is therefore understandable that a mass close to the diaphragm may be mistaken for a congenital diaphragmatic hernia because of the location, morphology and potential phrenic nerve compression. Post-natal diagnosis may also be misleading as many mediastinal cystic masses have similar appearances on imaging. Therefore, as well as cystic architecture, special consideration needs to be given to the anatomical location and effect on local structures.
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spelling pubmed-25181562008-08-20 Challenges in the prenatal and post-natal diagnosis of mediastinal cystic hygroma: a case report Nazir, Sarfraz Ahmed Raza, Syed Arsalan Nazir, Sheraz Sherwood, William Bowker, Colene Lakhoo, Kokila J Med Case Reports Case Report INTRODUCTION: Cystic hygroma is a benign congenital neoplasm that mostly presents as a soft-tissue mass in the posterior triangle of the neck. Pure mediastinal lesions are uncommon; the vast majority are asymptomatic and are an incidental finding in adulthood. The diagnosis is often made intra- or postoperatively. Prenatal identification is exceptional and post-natal diagnosis also proves challenging. CASE PRESENTATION: We report one such case that was mistaken for other entities in both the prenatal and immediate post-natal period. Initial and follow-up antenatal ultrasound scans demonstrated a multicystic lesion in the left chest, and the mother was counselled about the possibility of her baby having a congenital diaphragmatic hernia. Initial post-natal chest radiographs were reported as normal. An echocardiogram and thoracic computed tomography scan confirmed a complex multiloculated cystic mediastinal mass. The working diagnoses were of a mediastinal teratoma or congenital cystic adenomatous malformation. At operation, the lesion was compressed by the left lung and was found to be close to the left phrenic nerve, which was carefully identified and preserved. After excision, histopathological examination of the mass confirmed the diagnosis of cystic hygroma. Postoperative dyspnoea was observed secondary to paradoxical movement of the left hemidiaphragm and probable left phrenic neuropraxia. This settled conservatively with excellent recovery. CONCLUSION: Despite the fact that isolated intrathoracic cystic hygroma is a rare entity, it needs to be considered in the differential diagnosis of foetal and neonatal mediastinal masses, particularly for juxtadiaphragmatic lesions. The phrenic nerve is not identifiable on prenatal ultrasound imaging, and it is therefore understandable that a mass close to the diaphragm may be mistaken for a congenital diaphragmatic hernia because of the location, morphology and potential phrenic nerve compression. Post-natal diagnosis may also be misleading as many mediastinal cystic masses have similar appearances on imaging. Therefore, as well as cystic architecture, special consideration needs to be given to the anatomical location and effect on local structures. BioMed Central 2008-08-01 /pmc/articles/PMC2518156/ /pubmed/18673546 http://dx.doi.org/10.1186/1752-1947-2-256 Text en Copyright © 2008 Nazir et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Nazir, Sarfraz Ahmed
Raza, Syed Arsalan
Nazir, Sheraz
Sherwood, William
Bowker, Colene
Lakhoo, Kokila
Challenges in the prenatal and post-natal diagnosis of mediastinal cystic hygroma: a case report
title Challenges in the prenatal and post-natal diagnosis of mediastinal cystic hygroma: a case report
title_full Challenges in the prenatal and post-natal diagnosis of mediastinal cystic hygroma: a case report
title_fullStr Challenges in the prenatal and post-natal diagnosis of mediastinal cystic hygroma: a case report
title_full_unstemmed Challenges in the prenatal and post-natal diagnosis of mediastinal cystic hygroma: a case report
title_short Challenges in the prenatal and post-natal diagnosis of mediastinal cystic hygroma: a case report
title_sort challenges in the prenatal and post-natal diagnosis of mediastinal cystic hygroma: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518156/
https://www.ncbi.nlm.nih.gov/pubmed/18673546
http://dx.doi.org/10.1186/1752-1947-2-256
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