Head and Neck Lymphatic Malformations
CT & MR Imaging - A brief Review
DOI:
https://doi.org/10.59667/sjoranm.v13i1.14Keywords:
Lymphatic malformations, Head and Neck, Computed Tomography (CT), Magnetic Resonance (MRI), Surgery, SclerotherapyAbstract
Vascular anomalies correspond to a group of lesions related to disorders of vascular development, which to date remain a diagnostic and therapeutic challenge for treating physicians. Lymphatic malformations (LM) are congenital malformations that manifest as benign hamartomatous tumors of the lymphatic vessels with a marked predilection for the head, neck and oral cavity. In general terms, LM are classified as macrocystic, microcystic or a combination of both depending on the size of the lesion, which can lead to anatomical alterations and even functional deficits. The aim of this article is to provide a brief and accurate review of head and neck lymphatic malformations considering their clinical aspects, imaging tools and treatment options.
References
1. Ma J, Biao R, Lou F, Lin K, Gao YQ, Wang ML, et al. Diagnosis and surgical treatment of cervical macrocystic lymphatic malformations in infants. Exp Ther Med. 2017 Aug 1;14(2):1293–8. https://doi.org/10.3892/etm.2017.4703.
2. Sun RW, Tuchin V V., Zharov VP, Galanzha EI, Richter GT. Current status, pitfalls and future directions in the diagnosis and therapy of lymphatic malformation. Vol. 11, Journal of Biophotonics. Wiley-VCH Verlag; 2018. https://doi.org/10.1002/jbio.201700124.
3. Bouatay R, Hmida B, Hajjej M, Farhati A, Harrathi K, Kolsi N, et al. Cervicofacial lymphatic malformations: diagnosis and management. Egyptian Journal of Otolaryngology. 2021 Dec 1;37(1). https://doi.org/10.1186/s43163-021-00143-4
4. Gnanavel A, Divya P, Vikram T. Cystic Hygroma - A Case Report and its Embryological Basis. Anatomy & Physiology. 2015;05(01). https://www.longdom.org/open-access/cystic-hygroma-a-case-report-and-its-embryological-basis-21777.html
5. Castel P, Carmona FJ, Grego-Bessa J, Berger MF, Viale A, Anderson K V., et al. Somatic PIK3CA mutations as a driver of sporadic venous malformations. Sci Transl Med. 2016 Mar 30;8(332). https://www.science.org/doi/10.1126/scitranslmed.aaf1164.
6. Mulliken JB, & GJ. Hemangiomas and Vascular Malformations in Infants and Children. Plast Reconstr Surg. 1982;69(3):412–20. https://journals.lww.com/plasreconsurg/abstract/1982/03000/hemangiomas_and_vascular_malformations_in_infants.2.aspx.
7. De Serres LM, Sie KCY, Richardson MA. Lymphatic Malformations of the Head and Neck A Proposal for Staging [Internet]. Vol. 121, Arch Otolaryngol Head Neck Surg. 1995. Available from: http://archotol.jamanetwork.com/ https://doi.org/10.1001/archotol.1995.01890050061012.
8. Li J, Zhong W, Geng X, Liu X, Zhang X, Wang Y, et al. Ultrasonographic diagnosis, classification, and treatment of cervical lymphatic malformation in paediatric patients: A retrospective study. BMC Pediatr. 2020 Sep 19;20(1). https://doi.org/10.1186/s12887-020-02337-w.
9. Snyder EJ, Sarma A, Borst AJ, Tekes A. Lymphatic Anomalies in Children: Update on Imaging Diagnosis, Genetics, and Treatment. AJR Am J Roentgenol. 2022 Jun;218(6):1089-1101. https://doi.org/10.2214/AJR.21.27200.
10. Romeo V, Maurea S, Mainenti PP, Camera L, Aprea G, Cozzolino I, et al. Correlative imaging of cystic lymphangiomas: ultrasound, CT and MRI com-parison. Acta Radiol Open. 2015 May 1;4(5) https://doi.org/10.1177/2047981614564911.
11. Chen W, Xu H, Lina Z, Xu M, Li X, Sun G. The value of MRI in the diagnosis of pediatric head and neck lymphatic malformations: A study of 46 surgical cases. Eur J Radiol. 2024 Jan 1;170. https://doi.org/10.1016/j.ejrad.2023.111260.
12. de Leacy R, Bageac D V., Manna S, Gershon BS, Kirke D, Shigematsu T, et al. A radiologic grading system for assessing the radiographic outcome of treatment in lymphatic and lymphatic-venous malformations of the head and neck. American Journal of Neuroradiology. 2021 Oct 1;42(10): 1859–64. https://doi.org/10.3174/ajnr.A7260.
13. Lerat J, Mounayer C, Scomparin A, Orsel S, Bessede JP, Aubry K. Head and neck lymphatic malformation and treatment: Clinical study of 23 cases. Eur Ann Otorhinolaryngol Head Neck Dis. 2016 Dec 1;133(6):393–6. https://doi.org/10.1016/j.anorl.2016.07.004.
14. Oosthuizen JC, Burns P, Russell JD. Lymphatic malformations: A proposed management algorithm. Int J Pediatr Otorhinolaryngol. 2010 Apr; 74(4):398–403. https://doi.org/10.1016/j.ijporl.2010.01.013.
15. Colbert SD, Seager L, Haider F, Evans BT, Anand R, Brennan PA. Lymphatic malformations of the head and neck - current concepts in management. British Journal of Oral and Maxillofacial Surgery. 2013;51(2):98–102. https://doi.org/10.1016/j.bjoms.2012.02.004.
16. Wiegand S, Wichmann G, Dietz A, Werner JA. Association between malformation type, location and functional deficits in lymphatic malformations of the head and neck in children. Eur Arch Otorhinolaryngol. 2023 May;280(5):2535-2540. https://doi.org/10.1007/s00405-023-07844-x.
17. Adams MT, Saltzman B, Perkins JA. Head and neck lymphatic malformation treatment: a systematic review. Otolaryngol Head Neck Surg. 2012 Oct; 147(4):627-39. https://doi.org/10.1177/0194599812453552
18. Grasso DL, Pelizzo G, Zocconi E, Schleef J. Lymphangiomas of the head and neck in children. Acta Otorhinolaryngol Ital. 2008 Feb;28 (1):17-20. https://pmc.ncbi.nlm.nih.gov/articles/PMC2640069/.
19. Perkins JA. New Frontiers in Our Understanding of Lymphatic Malformations of the Head and Neck: Natural History and Basic Research. Otolaryngol Clin North Am. 2018 Feb;51(1):147-158. https://doi.org/10.1016/j.otc.2017.09.002.
20. Konuthula, Neeraja; Bindschadler, Michael; Perez, Francisco A; Shivaram, Giri M; Bly, Randall A; Friedman, Seth D; Perkins, Jonathan A. Quantifying Head and Neck Lymphatic Malformation Volume and Composition During Treatment. Journal of Vascular Anomalies 3(1):p e037, March 2022. https://doi.org/10.1097/JOVA.0000000000000037.
21. Wu C, Song D, Guo L, Wang L. Refractory Head and Neck Lymphatic Malformation in Infants Treated With Sirolimus: A Case Series. Front Oncol. 2021 Jul 16;11:616702. https://doi.org/10.3389/fonc.2021.616702.
22. De Maria L, De Sanctis P, Balakrishnan K, Tollefson M, Brinjikji W. Sclerotherapy for lymphatic malformations of head and neck: Systematic review and meta-analysis. J Vasc Surg Venous Lymphat Disord. 2020 Jan;8(1):154-164. https://doi.org/10.1016/j.jvsv.2019.09.007.
23. Lal A, Gupta P, Singhal M, Sinha SK, Lal S, Rana S, Khandelwal N. Abdominal lymphatic malformation: Spectrum of imaging findings. Indian J Radiol Imaging. 2016 Oct-Dec;26(4):423-428. https://doi.org/10.4103/0971-3026.195777.
24. Wiegand S, Dietz A, Wichmann G. Efficacy of sirolimus in children with lymphatic malformations of the head and neck. Eur Arch Otorhinolaryngol. 2022 Aug;279(8):3801-3810. https://doi.org/10.1007/s00405-022-07378-8.
25. Larson AS, Brinjikji W, Anderson KR, Tollefson M, Michelle Silvera V, Guerin JB. Imaging of benign cervico-facial vascular anomalies and associated syndromes. Interv Neuroradiol. 2022 Jun;28(3): 364-374 https://doi.org/10.1177/15910199211034989.
26. Bouwman FCM, Klein WM, de Blaauw I, Woiski MD, Verhoeven BH, Botden SMBI. Lymphatic malformations adjacent to the airway in neonates: Risk factors for outcome. J Pediatr Surg. 2021 Oct;56(10):1764-1770. https://doi.org/10.1016/j.jpedsurg.2021.03.011.
27. Vrinceanu D, Dumitru M, Marinescu A, Dorobat B, Palade OD, Manole F, Muresian H, Popa-Cherecheanu M, Ciornei CM. New Insights into Cervicofacial Vascular Anomalies. J Clin Med. 2024 Jun 15;13(12):3515. https://doi.org/10.3390/jcm13123515.
28. Dhagat PK, Jain M, Farooq A. MRI evaluation of soft tissue vascular malformations. Indian J Radiol Imaging. 2020 Apr-Jun;30(2):184-189. https://doi.org/10.4103/ijri.IJRI_439_19.
29. Iwai T, Minamiyama S, Sugiyama S, Mitsudo K. Lymphatic malformation in the buccal region. Eur Ann Otorhinolaryngol Head Neck Dis. 2022 Oct;139 (5):313-314. https://doi.org/10.1016/j.anorl.2021.12.005.
30. Gupta R, Bhandari A, Navarro OM. Pediatric Vascular Anomalies: A Clinical and Radiological Perspective. Indian J Radiol Imaging. 2023 Sep 16;34(1):103-127. https://doi.org/10.1055/s-0043-1774391.
31. Crivelli L, Millischer AE, Sonigo P, Grévent D, Hanquinet S, Vial Y, Alamo L. Contribution of magnetic resonance imaging to the prenatal diagnosis of common congenital vascular anomalies. Pediatr Radiol. 2021 Aug;51(9):1626-1636. https://doi.org/10.1007/s00247-021-05031-w.
32. Cronan J, Gill AE, Shah JH, Hawkins CM. The Role of Interventional Radiologists in the Treatment of Congenital Lymphatic Malformations. Semin Intervent Radiol. 2020 Aug;37(3):285-294. https://doi.org/10.1055/s-0040-1713446.
33. Lee S, Ko SY, Park WJ. Macrocystic lymphatic malfor-mation of the chest wall and axilla: A case report in a 45-year-old man. Radiol Case Rep. 2021 Nov 10;17(1):152-155. Erratum in: Radiol Case Rep. 2023 Feb 09;18(4):1652. https://doi.org/10.1016/j.radcr.2021.10.001.
34. Brahmbhatt AN, Skalski KA, Bhatt AA. Vascular lesions of the head and neck: an update on classification and imaging review. Insights Imaging. 2020 Feb 7;11(1):19. https://doi.org/10.1186/s13244-019-0818-3.
35. Schmidt VF, Masthoff M, Czihal M, Cucuruz B, Häberle B, Brill R, Wohlgemuth WA, Wildgruber M. Imaging of peripheral vascular malformations - current concepts and future perspectives. Mol Cell Pediatr. 2021 Dec 7;8(1):19. https://doi.org/10.1186/s40348-021-00132-w.
36. Bhari N, Agarwal A, Asritha CVV, Panda M, Mahajan R. Vascular Malformations. Indian Dermatol Online J. 2024 Apr 23;15(3):415-430. https://doi.org/10.4103/idoj.idoj_633_23.
37. Embrechts JLA, Hiddinga S, Bot JC, Hendrickx JJ, van Eekelen R, Ket JCF, Leemans CR, de Bree R. Surgery versus sclerotherapy versus combined therapy in head and neck lymphatic malformations in the pediatric population: systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2024 Sep;281(9):4529-4539.https://doi.org/10.1007/s00405-024-08661-6.
38. Healy J, Balcazar JA, Rivera L, Ruas V. Rapid lymphatic malformation expansion: Imaging, association with asymptomatic Streptococcus infection, multidisciplinary management, and therapeutic approach. Radiol Case Rep. 2023 Jun 26;18(9): 3162-3168. https://doi.org/10.1016/j.radcr.2023.06.029.
39. Poget M, Fresa M, El Ezzi O, Saliou G, Doan MT, de Buys Roessingh A. Lymphatic malformations in children: retrospective review of surgical and interventional management. Pediatr Surg Int. 2022 Dec 5;39(1):36. https://doi.org/10.1007/s00383-022-05320-x.
40. Hyvönen H, Salminen P, Kyrklund K. Long-term outcomes of lymphatic malformations in children: An 11-year experience from a tertiary referral center. J Pediatr Surg. 2022 Dec;57(12):1005-1010. https://doi.org/10.1016/j.jpedsurg.2022.07.024.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 ILSON SEPULVEDA, Aristides A. Capizzano, Francisco Rivas-Rodriguez, Allison Baez
This work is licensed under a Creative Commons Attribution 4.0 International License.
This license requires that reusers give credit to the creator. It allows reusers to distribute, remix, adapt, and build upon the material in any medium or format, even for commercial purposes.
