SONOWORLD : Abdominal and splenic lymphangioma

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Abdomen » Spleen

Abdominal and splenic lymphangioma, with prior history of residual abdominal lymphangioma

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Author(s) :

Pamela T. Johnson, MD

Zoltan Harkanyi, MD, PhD

Presentation This young, female patient presented with a painful mass in the left lower quadrant of the abdomen.

Caption: Sagittal image of the left lower quadrant.

Description: Sonogram shows an oval shape cystic mass in the left lower quadrant of the abdomen anterior to the psoas muscle. The mass is separate from the urinary bladder and the ovaries.

Caption: Transverse sonogram of the left lower quadrant.

Description: Sonogram shows an oval shape cystic mass in the left lower quadrant of the abdomen anterior to the psoas muscle. The mass is separate from the urinary bladder and the ovaries.

Caption: Sagittal image of spleen and left kidney.

Description: A cystic, rounded mass is present in the spleen.

Caption: Color Doppler image of cystic spleen mass.

Description: Color Doppler shows no internal vascularity.

Caption: Sagittal image of the spleen.

Description: Several additional cystic masses are present in the spleen.

Differential Diagnosis Abdomen: ovarian cyst, hematoma, abscess

Spleen: Echinoccocus cyst, hematoma

Final Diagnosis Lymphangioma of the abdomen and spleen.

Discussion Lymphangioma is a rare vascular anomaly, histologically comprised of lymph-filled, endothelium-lined vascular channels. These cystic masses arise in the superficial tissues as well as the abdomen, and multiple lymphangiomas may be present in the setting of angiomatosis.

Lymphangiomas are classified according to the size of the lymph channels as capillary, cavernous and cystic. The typical ultrasound appearance is a hypoechoic cyst with septations, which may contain internal debris. On color Doppler, they have no internal vascularity.

The differential diagnosis of a splenic cyst in a child includes "true cysts", such as congenital cysts, Ecchinococcal cysts and epidermoid cysts, as well as pseudocysts which can arise after trauma or splenic infarction.

The treatment of lymphangiomas includes surgical excision, which may be only partially successful with residual masses, as seen in this case. An alternative treatment is ultrasound guided puncture and sclerotization.

Case References Paterson A, Frush DP, Donnelly LF et al. A Pattern-oriented approach to splenic imaging in infants and children. Radiographics 1999; 19: 1465-1485.

Technical Details

GE, Logiq 700, 4-6 MHz convex and 5-10 MHz linear transducer

Follow Up

No change on follow up imaging 6 months later.

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