A Giant Cystic Hygroma in Adult – A Surgical Challenge

Cystic hygroma is a type of lymphangioma which generally seen in infant. In adults,less than 150 cases have been reported in the literature. We present here a case of 27 year old male having giant cystic hygroma in neck with extension into mediastinum. BMR Medicine ISSN 2349-0756 www.bmrjournals.com 2 BMR Journals| bmrjournals.com Fig 1. Soft and cystic swelling presenting in the neck extending from the level of thyroid cartilage upto sternum On fine needle aspiration, clear fluid with very few cells were obtained. On CT of neck, a soft tissue homogenous swelling with well defined margins was appreciated extending from the level of hyoid till the level just above arch of aorta. The mass was seen to have a encroaching posterior mediastinal space. The mass was non enhancing on contrast.Trachea was shifted to right side with slightly compromised lumen. The carotid artery was anterolaterlly. Fig 2 and 3. CT showing the homogenous non enhancing mass with displacement of carotid posterolaterally Fig 4. Sagittal frame of CT showing the lower extent of the swelling enroaching mediastinum The patient was taken up for excision of mass. Under general anaesthesia, a horizontal inscision was taken in the neck crease. The subplatysmal flaps were elevated. The swelling was delineated except in the region of inferior extent. The meticuluous dissection was done with separation and delineation of great vessel and vagus nerve was done. The swelling was dissected of the oesophagus and with traction was peeled out from the mediastinum. The histopathological report confirmed it to be a cystic hygroma. BMR Medicine ISSN 2349-0756 www.bmrjournals.com 3 BMR Journals| bmrjournals.com Fig 5. Cystic hygroma specimen