Pediatric Cystic Hygroma
A cystic hygroma (CH) is a lymphatic lesion that usually affects the head and neck and is caused by the obstruction of a lymphatic drainage pathway. Most cystic hygromas are evident at birth, with 80 to 90% of cases diagnosed before the child turns 2.
These benign lesions are usually congenital but may also be acquired following trauma, surgery or systemic inflammations, and can manifest as single or multiple macrocystic lesions. CH occurs in about 1 per 10,000 births.
Cystic hygromas are seen at birth as a soft, compressible, non-tender and translucent masses. The child may also have related complications, including respiratory distress, dysphagia and fever.
During pregnancy CHs are often encountered during an abdominal ultrasound in the first trimester, and an MRI will show their size. An alpha-fetoprotein screening of the mother may help confirm diagnosis in about 50% of cases.
A prenatal diagnosis is associated with other anomalies in at least 50% of cases. These include Turner's and Down's syndrome.
Respiratory distress and recurrent infections require treatment. The cyst can be aspirated as a temporary measure, to reduce its size and the pressure it places on the airway and feeding passages.
The suggested treatment is surgical removal, but increasingly, some patients are treated with laser excision or radio frequency ablation.
Cystic hygroma is a manageable lesion in children. Surgery is used to excise the abnormal tissues, but in 20% of cases, it recurs. The outcome also depends on where these lesions are located; beyond cosmetic damage, there could be an impact on airway, nerves and vessels.