A 42-year-old woman had presented to the outpatient clinic because of a swelling of the left cervical region. Her medical history was remarkable for multiyear episodes of recurrent cervical swelling with abdominal pain that always regressed spontaneously. The physical examination showed a soft nontender mass in the left supraclavicular fossa without pain or skin redness (Fig A/Cover). Magnetic resonance lymphography (Fig B) without contrast injection showed a marked dilation of the thoracic duct (arrowhead). We also visualized a dilation of the cervical lymphatic duct network (long arrow). The terminal part of the thoracic duct showed a segmental dilation ≤13 mm with visualization of lymphatic intraluminal obstruction (LIO; short arrows).
Ultrasound examination (Fig C) focused on this area confirmed the LIO of the terminal portion of the thoracic duct. No other lymphatic or vascular malformations were demonstrated by thoracoabdominal computed tomography or magnetic resonance imaging. One week later, the patient had recovered uneventfully with complete resorption of the cervical swelling. Because the cervical swelling had spontaneously resolved, surgery was not considered.1 A supraclavicular mass can arise from infectious disease, a branchial clef cyst, or a benign or malignant tumor. LIO of the thoracic duct is a rare condition that can cause recurrent swelling of the cervical region.2 Magnetic resonance lymphography without contrast media injection allows for easy visualization of the lymphatic duct network and can directly demonstrate the LIO without the need to inject contrast media.3,4
The patient gave her written informed consent for the report of her case details and imaging studies.
Footnotes
Author conflict of interest: none.
The editors and reviewers of this article have no relevant financial relationships to disclose per the Journal policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.
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