Cystic Lymphangioma (Differential Diagnosis Second Branchial Cyst)

A differentiation of a lateral cyst of the neck from a cystic lymphangioma may be more difficult. For the supposed diagnosis of a cystic lymphangioma, the history is useful: In tuha_16a_n.jpg the changing size or in tuha_16b_n.jpg the sudden manifestation; both incidents either follow an intermittent or an acute accumulation of lymph or are due to an acute hemorrhage. tuha_16a_n.jpg: This large cystic mass on the left side of the neck of a 2.2-year-old boy differs from a lateral cyst of the neck by its topographic pattern of distribiution. $$tuha_3??££See figure for comparison§§ . In addition, the mass is smoother and less tense on palaption, and multilocular on ultrasound with clear fluid except in case of acute hemorrhage. tuha_16b_n.jpg: The same is true for the mass of this 5-month-old infant. In cystic lymphangioma there are transitional forms toward a craniofascial localization. $$tuha_10??nr=2££See figure for comparison§§ with lateral cyst of the neck beneath the right angle of the lower jaw which is an unusual presentation. tuha_16c_n.jpg: With a length of 6 cm, the preparation of an excised cystic lymphangioma is relatively large for a 2.3-year-old child. Multiple large cysts can be suspected spreading between the neck structures; they do not contain the usual yellowish fluid, but are bluishly discolored due to a hemorrhage, or an additional hemangioma. tuha_16d_n.jpg: The midline localization of this cystic lymphangioma which became visible all at once is tricky, of which the preparation has been discussed under figure tuha_16c_n.jpg. Nevertheless, the visible and palpable mass does not fit the picture of a midline thyroglossal duct cyst with this infrequent localization.