Images in Clinical Practice

Indian Pediatrics 2000;37: 1139-1140

Cystic Hygroma

A 4-day-old male neonate weighing 2.8 kg presented with massive bilateral swelling of the neck, with involvement of the tongue and larynx resulting in airway obstruction (Fig. 1). The tongue was so large that the child could not close his mouth. Emergency sub-total excision was done. Post-operatively, the child could not be extubated and required ventilatory support for 4 days. Eventually, he required tracheostomy, which needed to be kept for almost a month. The remaining part of the lymphangioma was excised at the age of six months.

A cystic hygroma of the neck is soft, watery and easily transilluminated; there is no other lesion that is quite so characterstic. It consists of thin-walled cysts with flat endothelium. During surgery, it often seems that the mass has the consistency of water-filled soap bubbles and there is no end to the infiltration of normal tissue. In spite of the extensive invasion of tissue planes, these are benign lesions.

About 75% of cystic hygromas are in the neck, 20% in the axilla (Fig. 2) and 5% on the trunk or extremity. Some 50 to 60% of cystic hygromas are present at birth, and practically, all of them are apparent by two years of age.

Yogesh Kumar Sarin,
Associate Professor and Head,
Department of Pediatric Surgery,
Maulana Azad Medical College,
New Delhi-110 002, India.

Fig. 1. Huge cystic hygroma in a neonate involving the face, neck and sublingual areas.	Fig. 2. A cystic hygroma of the axilla. Also note its presence in the unusual sites such as anterior to the manubrium and the left upper limb right down to the fingers. Excision of these lesions led to lymphedema of the extremity.