Colour Doppler ultrasound findings in the nail in cystic fibrosis.

ners) may see the condition, and where there is often a tendency to avoid invasive and expensive diagnostic procedures. Unlike the classic, frog spawn appearance of lymphangioma circumscriptum, lymphangiectasias of the vulva present as large clusters of vesicles and papules or oedematous polypoid nodules mimicking genital warts. Hence, vulvar LC needs to be differentiated from various dermatological disorders for which treatment methods are different, such as genital warts, herpes zoster, molluscum contagiosum and leiomyoma. Histologically, numerous dilated lymphatics in the superficial and papillary dermis are seen. There is clear fluid and, less frequently, red blood cells in their lumina. In the overlying epidermis there is some degree of acanthosis and hyperkeratosis. The surrounding stroma shows scattered lymphocytes. Recognition and appropriate treatment of vulval lymphangiectasia is important primarily because the lesions may act as portals of entry for infection. In addition, persistent leakage of lymphatic fluid may be mistaken for urinary incontinence. There is no standard therapy for the management of LC. The most common procedures are abrasive therapy, sclerotherapy, electrocoagulation and surgical resection. Even with the best treatment option, recurrence is common. In our case, the obstruction of the lymphatics by an overtly distended gravid uterus appears to be the most plausible explanation for the vulvar lymphangiectasia occurring in the setting of a twin pregnancy, resolving spontaneously in the postpartum period with the physiological involution of the uterus.