Lymphangioma (Mesenteric Cyst)

Published on 19/07/2015 by admin

Filed under Radiology

Last modified 19/07/2015

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 Can arise from or involve virtually any structure

• Circumscribed cystic mass with variable density

image Typically water density (near 0 HU) or chylous (< -20 HU), and only rarely hemorrhagic
image No internal enhancement
image Can be multiloculated (± septations) with “feathery” appearance
image Soft lesions without mass effect: Easily indented by surrounding structures, such as mesenteric vessels/bowel
image Usually hypointense on T1WI MR and hyperintense on T2WI

TOP DIFFERENTIAL DIAGNOSES

• Loculated ascites
• Gastrointestinal duplication cyst
• Pancreatic pseudocyst
• Peritoneal inclusion cyst
• Cyst or cystic tumor arising from visceral organ

CLINICAL ISSUES

• Symptoms are rare (particularly in adults)

image Rare symptoms due to mass effect, superinfection, or internal hemorrhage
• Surgery is treatment of choice when necessary

DIAGNOSTIC CHECKLIST

• Differentiate from other primary cystic lesions or tumors of visceral organs
image
(Left) Axial CECT shows a complex cystic mass in the mesentery sandwiching a small bowel segment image. The mass is near water density and has small foci of calcification in its septa and peripheral walls image. The soft nature of the mass is indicated by the absence of bowel obstruction.

image
(Right) Axial CECT shows a complex water-density mass in the mesentery, immediately adjacent to the pancreas and duodenum. The mass is divided by multiple septa image, which, like the peripheral walls, are thin.
image
(Left) Axial CECT in a female patient shows a large, cystic mass with multiple septations image filling much of the lower abdomen. Note the calcifications image in the septa and the peripheral walls.

image
(Right) Axial CECT in a female patient shows a cystic retroperitoneal mass image with subtle septa and a small focus of calcification image. The mass was resected and found to contain chylous fluid (typical of a lymphangioma) and an epithelial lining, features that help account for the variety of names for this tumor.

TERMINOLOGY

Synonyms

• Lymphoepithelial cyst, cystic lymphangioma, mesenteric cyst, lymphatic malformation

Definitions

• Congenital benign malformation of lymphatic system arising due to failure of embryologic lymphatic development
• Generic descriptive term for benign congenital cystic mass arising in mesentery or omentum

IMAGING

General Features

• Best diagnostic clue

image Cystic mass (without mass effect) in mesentery or retroperitoneum
• Location

image Majority of lymphangiomas arise in head, neck, or axillae
image Lymphangiomas of abdomen rare (7% of all lymphangiomas)

– Can involve multiple compartments of peritoneum or retroperitoneum
– Can arise from or involve virtually any structure
image Lymphangiomatosis: Widespread lymphangiomas (usually liver, spleen, mediastinum, lungs, mesentery)

– Usually presents in infants and young children
• Size

image Few mm to 40 cm in diameter
• Morphology

CT Findings

• Circumscribed cystic mass with variable density

image Typically water density (near 0 HU) or chylous (< -20 HU), with lesions rarely demonstrating hemorrhagic contents

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