Lymphangioma of the chest wall.

HM Kocher, T Vijaykumar, RS Koti, RD Bapat 
 Department of General Surgery, Seth GS Medical College, Parel, Mumbai.

Correspondence Address:
H M Kocher
Department of General Surgery, Seth GS Medical College, Parel, Mumbai.

Full Text

::   Introduction

Lymphangiomas are developmental anomalies known to occur in the neck, axilla and rarely in the mediastinum, retroperitoneum, groin and pelvis[1]. They are differentiated from hemangiomas in that they do not contain erythrocytes[2]. They can be of simple capillary, cavernous or cystic types[2] Neck and axillary lymphangiomas commonly present at birth with or without respiratory compromise. Isolated chest wall lymphangioma is a rare condition, which is being reported for the first time[3].

::   Case report

A 18-year-old, young healthy male presented with a congenital swelling on the right chest wall, with intermittent discharge of clear yellow coloured fluid, following trauma 2 months before. There were no other swellings anywhere else in the body. There was no history of or evidence of tuberculosis. On examination there was a 12 cm x 12 cm x 1.5 cm soft, diffuse. Superficial swelling, which was fluctuant and transluminant extending from the 5th to 9th ribs between the right midclavicular and the right midaxillary lines. Cough impulse was negative. Aspirate showed straw-coloured clear fluid with proteins 6.69 gm% and 21 leucocytes and no erythrocytes. Contrast studies by needle method showed a superficial, well-defined, loculated chest wall swelling.

In the operating room, a thin walled sac with patchy fibrosis was seen below the subcutaneous plane, extending from serratus anterior to the pectoral group of muscles and overlying the external oblique aponeurosis. Most of the cyst wall was removed and the part in between the serratus digitations was left behind. Closure over a suction drain was done. Postoperative recovery was uneventful. Minimal lymphatic collection was detected till 3 weeks postoperatively, which was successfully managed by nondependent aspiration, injection of hyper-tonic saline and compression dressing. Histopathology was consistent with lymphangioma with patchy fibrosis. Followup at the end of one month showed complete resolution.

::   Discussion

Approximately 65% of lymphangiomas are apparent at birth, and 90% appear at the end of second year[3]. The size of the lymphangioma appears to be directly related to the degree of obstruction of lymphaticovenous drainage as evidenced by histologic appearance[3] & and by studies of microvascular circulation with Xenon[133] clearance. As recorded in literature, more than 75% appear in the cervico-facial region. 20% in the axillary region, and the rest in the mediastinum, retro-peritoneum, pelvis and groin[2] Chest wall lymphangioma have not been reported to date[3].

Contrast studies are helpful to delineate extent, communication with intrathoracic structure, and lymphatic/venous communication in the absence of Xenon[133] clearance studies.

Excision is recommended principally for disfigurement (cosmesis) and for fear of complications like infection, sinus (as in this case), compression of vital structure or haemorrhage[3] Malignant degeneration is unlikely[3] Residual lymph collection is effectively man aged by aspiration, sclerosants and compression[4].

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