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Image of the Month—Diagnosis
Arch Surg. 2005;140:706.
Answer: Cystic Lymphangioma
Intra-abdominal cystic lymphangiomas are extremely rare entities whose origins are related to congenital defects of the lymphatics. Lymphangiomas generally occur in children, who remain asymptomatic until early adulthood. Lesions may be discovered incidentally or progress to produce vague and chronic abdominal symptoms, possibly secondary to a mass effect.1 Lymphangiomas do not generally regress. As such, surgical intervention is preferred and, with complete resection, offers an excellent prognosis. Two independent studies reported recurrences in 10% of patients in whom primary resection was incomplete.1-2 Chylous ascites may occur if the stem of the cyst and feeding lymphatics are unsuccessfully ligated.3 Management of this condition may include the placement of drains as they facilitate the injection of fibrinogen and thrombin, especially when drainage is persistent.4
Depending on the size and location of the mass, laparoscopic resection has been proposed as a potentially safe and minimally invasive means of surgical management.5-6 However, complete resection may be too difficult or dangerous when compression or infiltration of vital structures is encountered.
Patients who refuse surgery or are poor candidates for laparoscopic resection may benefit from a combination of percutaneous image-guided drainage and sclerotherapy. With no major complications reported, this approach provides complete resolution in 66% of patients and reduces the lesion size in 25% of patients by more than 50%.7
| Submissions
The Editor welcomes contributions to the "Image of the Month." Send manuscripts to Archives of Surgery, Johns Hopkins Medical Institutions, 720 Rutland Ave, Ross 759, Baltimore, MD 21205; (443) 287-0026; e-mail: archsurg{at}jama-archives.org. Articles and photographs accepted will bear the contributor’s name. Manuscript criteria and information are per the "Instructions for Authors" for Archives of Surgery. No abstract is needed, and the manuscript should be no more than 3 typewritten pages. There should be a brief introduction, 1 multiple-choice question with 4 possible answers, and the main text. No more than 2 photographs should be submitted. There is no charge for reproduction and printing of color illustrations.
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AUTHOR INFORMATION
Correspondence: P. Marco Fisichella, MD, Department of Surgery, University of Illinois at Chicago, 840 S Wood St (M/C 958), Chicago, IL 60612-7322 (pfisiche{at}uic.edu).
Accepted for Publication: February 25, 2005.
REFERENCES
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1. Steyaert H, Guitard J, Moscovici J, Juricic M, Vaysse P, Juskiewenski S. Abdominal cystic lymphagioma in children: benign lesions that can have a proliferative course. J Pediatr Surg. 1996;31:677-680.
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2. Okur H, Kucukaydin M, Ozokutan BH, Durak AC, Kazez A, Lose O. Mesenteric, omental, and retroperitoneal cysts in children. Eur J Surg. 1997;163:673-677.
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3. Hauser H, Mischinger HJ, Beham A, et al. Cystic retroperitoneal lymphangiomas in adults. Eur J Surg Oncol. 1997;23:322-326.
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4. Giberson WG, McCarthy PM, Kaufman BH. Fibrin glue for the treatment of persistent lymphatic drainage. J Pediatr Surg. 1988;23:1188-1189.
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5. Tsukamoto T, Tanaka S, Yamamoto T, et al. Laparoscopic excision of retroperitoneal cystic lymphangioma: report of a case. Surg Today. 2003;33:142-144.
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6. Chella B, Bona D, Gazzano G, Bellaviti N, Bonavina L. Abdominal cystic lymphangioma: a case report. Chir Ital. 2004;56:463-466.
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7. Won JH, Kim BH, Kim CH, Park SW, Kim MD. Percutaneous sclerotherapy of lymphangiomas with acetic acid. J Vasc Interv Radiol. 2004;15:595-600.
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SECTION EDITOR: GRACE S. ROZYCKI, MD
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