Cystic hygromas are congenital lymphatic malformations found most commonly in the neck in infants and children less than 2 years of age. They present as nontender, compressible, unilocular, or multilocular masses with thin, transparent walls filled with straw-colored fluid. Unlike hemangiomas, these lesions rarely undergo spontaneous involution. The vast majority tend to grow and infiltrate adjacent structures. In cases where the tongue is involved, they may lead to upper airway obstruction. The differential diagnosis includes branchial arch remnants, thyroglossal duct cysts, cystic teratomas, cervical lymphadenopathy, and other primary neoplastic diseases.
Management and Disposition
Elective surgical removal is the treatment of choice in the vast majority of cases and especially in emergent situations, since these lesions do not regress and may compress local tissues. Extent of the lesion should be evaluated through further imaging prior to its removal. The earlier these lesions can be removed, the better is the cosmetic result. Aspiration of the lesion, with or without injection of a sclerosing agent, is another therapeutic option.
Cystic Hygroma. A bright, supraclavicular, soft, boggy, compressible mass consistent with cystic hygroma. (Photo contributor: Richard M. Ruddy, MD.)
Rapid enlargement of a cystic hygroma is most likely due to bleeding or infection. This can result in airway compromise.
Chromosomal abnormalities are found in a significant number of infants with cystic hygromas. These lesions are frequently associated with Noonan, Turner, and Down syndromes.