A giant cystic lymphangioma of the abdominal body wall in a child

An 8-year-old boy was admitted to our vascular center with a painless mass on the right abdominal wall that had been gradually increasing since his birth. He had not undergone any workup of the mass in the previous 8 years, and he had no fever or any other associated symptoms. On physical examination, a giant, soft, well-defined lump was found in the right side of the abdominal wall (A). He underwent a computed tomography scan, which showed a giant mass on the right abdominal wall (B). Contrast-enhanced magnetic resonance imaging confirmed a 390-mm × 230-mm mass, with altered signal intensity involving the soft tissues of the anterior, lateral, and posterior abdominal wall on the right side. There were multiple hypointense intralesional septations but no intra-abdominal extension (C/Cover). This mass was consistent with a diagnosis of cystic lymphangioma. Surgical resection was recommended; however, the patient's guardians refused further surgical treatment and chose conservative treatment with observation because of financial difficulties.

Cystic lymphangioma is a benign congenital malformation of the lymphatic system, affecting mostly the craniofacial region, neck, and chest. It is usually discovered during childhood accidentally, and a location in the abdominal body wall is uncommon.1, 2, 3 The natural course of the cystic lymphangioma is a slow progression in size. It is usually asymptomatic but can be symptomatic, depending on the size, which can also cause abdominal discomfort because of its mass effect and sometimes complications such as peritonitis by rupture, hemorrhage, or infection.³ Contrast-enhanced magnetic resonance imaging is the most important diagnostic tool because it can show the extent of the lesion and differentiate it from nonvascular and other vascular lesions.² Complete surgical excision is recommended if there is no contraindication for surgical treatment.⁴

Disclosures

None.

Appendix

Cover Image.