eMedicine Specialties > Radiology > Obstetrics/Gynecology

Cystic Hygroma: Imaging

Author: Durre Sabih, MBBS, MSc, Visiting Faculty, Department of Nuclear Medicine, Pakistan Institute Applied Sciences and Nishtar Medical College; Director, Multan Institute of Nuclear Medicine and Radiotherapy
Coauthor(s): Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia; Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute; Zahida Sabih, MBBS, MSc,
Contributor Information and Disclosures

Updated: Jul 17, 2008

Radiography

Findings

Plain radiography is typically not used because it employs ionizing radiation and because of its inability to depict the internal contents of the soft-tissue mass in the neck.

Computed Tomography

Findings

CT scanning is avoided because it employs ionizing radiation. However, if the reasons to use CT scanning are overwhelming, the extent of pathology can be assessed with this modality.

Magnetic Resonance Imaging

Findings

The long acquisition times inherent to most acquisition sequences make the use of MRI impractical unless special fast sequences are performed. In optimal settings, MRI can provide exquisite anatomic detail, and it can be especially helpful in identifying additional pathology, as well as in determining the extent of the disease. On T1-weighted sequences, cystic hygromas present a low signal intensity; and on T2-weighted sequences, they demonstrate a high signal intensity with low-signal septations of variable thickness. Hemorrhagic cysts or cysts possessing chylous lipid contents may demonstrate a high signal intensity on T1-weighted sequences. A fluid-fluid level has been recorded with hemorrhagic cysts.13

Gadolinium-based contrast agents (gadopentetate dimeglumine [Magnevist], gadobenate dimeglumine [MultiHance], gadodiamide [Omniscan], gadoversetamide [OptiMARK], and gadoteridol [ProHance]) have been linked to the development of nephrogenic systemic fibrosis (NSF) or nephrogenic fibrosing dermopathy (NFD). For more information, see the eMedicine topic Nephrogenic Fibrosing Dermopathy.

NSF/NFD has occurred in patients with moderate to end-stage renal disease after being given a gadolinium-based contrast agent to enhance MRI or magnetic resonance angiography (MRA) scans. NSF/NFD is a debilitating and sometimes fatal disease. Characteristics include red or dark patches on the skin; burning, itching, swelling, hardening, and tightening of the skin; yellow spots on the whites of the eyes; joint stiffness with trouble moving or straightening the arms, hands, legs, or feet; pain deep in the hip bones or ribs; and muscle weakness. For more information, see the FDA Public Health Advisory or Medscape.

Degree of Confidence

MRI can be used with a high degree of confidence in the diagnosis of cystic hygroma. Usually, further imaging modalities are not needed if good-quality MRI studies are obtained.

False Positives/Negatives

Although a hemangioma can appear similar to a cystic hygroma, the hemangioma usually is found in a different location, and after contrast is administered, feeding vessels may be seen, in addition to tumor enhancement.   

Ultrasonography

Findings

US is the modality of choice in the diagnosis of fetal cystic hygroma.14 The classic finding is a cystic mass with multiple septa that appears as multiple, asymmetric, thin-walled cysts related to the posterior aspect of the neck. These masses are associated with aneuploidy. If the hygroma is large, the cysts can extend to the lateral or even to the anterior aspects of the neck. The presence of a nuchal ligament, which is demonstrated as a posterior midline band extending through the cyst, is a characteristic finding.13

Oligohydramnios can occur. When it does, it can limit the discovery of cardiac or other visceral abnormalities that can coexist with cystic hygroma. These abnormalities should be investigated. Hydrops may be diagnosed by identifying body wall edema, pleural effusions, and/or fetal ascites.15

Degree of Confidence

US remains an operator-dependent modality and must be performed by a trained individual who is skilled in evaluating fetal anomalies. A thorough fetal examination results in a high confidence level. Most often, US is the only technique that is necessary for prenatal diagnosis.

False Positives/Negatives

Fetal cystic hygromas should be differentiated from posterior encephaloceles, in which an underlying skull defect is present, and cervical myelomeningoceles, in which an underlying vertebral defect is present.

A common artifact is caused by the presence of loops of umbilical cord near the cervical spine of the fetus. On occasion, these loops can simulate cervical cysts. A Doppler ultrasonography evaluation demonstrates characteristic umbilical flow signals from this area. Fetal cystic hygroma must also be differentiated from other neck masses and cysts, such as anterior cystic hygromas, goiters, and cervical teratomas.

Compared with other masses, purely anterior cystic masses in the fetal neck have a different and better prognosis, and many resolve spontaneously.

More on Cystic Hygroma

Overview: Cystic Hygroma
Imaging: Cystic Hygroma
Follow-up: Cystic Hygroma
Multimedia: Cystic Hygroma
References
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References

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  2. Jenderny J, Schmidt W, Hecher K, et al. Increased nuchal translucency, hydrops fetalis or hygroma colli. A new test strategy for early fetal aneuploidy detection. Fetal Diagn Ther. Jul-Aug 2001;16(4):211-4. [Medline].

  3. [Best Evidence] Graesslin O, Derniaux E, Alanio E, et al. Characteristics and outcome of fetal cystic hygroma diagnosed in the first trimester. Acta Obstet Gynecol Scand. 2007;86(12):1442-6. [Medline].

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Further Reading

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Keywords

cystic hygroma, cystic lymphangiomas, familial nuchal blebs, FCH, fetal cystic hygromas, cystic hygroma colli, jugular lymphatic obstructive sequences, moist tumors, lymphatic malformations, Turner syndrome, Turner's syndrome, trisomy 21, Down syndrome, Down's syndrome, trisomy 18, Edwards syndrome, Noonan syndrome, Noonan's syndrome

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Contributor Information and Disclosures

Author

Durre Sabih, MBBS, MSc, Visiting Faculty, Department of Nuclear Medicine, Pakistan Institute Applied Sciences and Nishtar Medical College; Director, Multan Institute of Nuclear Medicine and Radiotherapy
Disclosure: Nothing to disclose.

Coauthor(s)

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP is a member of the following medical societies: American Institute of Ultrasound in Medicine, Radiological Society of North America, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Zahida Sabih, MBBS, MSc, 
Disclosure: Nothing to disclose.

Medical Editor

Harris L Cohen, MD, FACR, Vice Chairman/Associate Chairman (Research Activities), Director, Division of Body Imaging, Professor of Radiology, Stony Brook School of Medicine; Visiting Professor of Radiology, Johns Hopkins School of Medicine
Harris L Cohen, MD, FACR is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, Association of Program Directors in Radiology, Radiological Society of North America, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Karen L Reuter, MD, FACR, Professor, Department of Radiology, Lahey Clinic Medical Center
Karen L Reuter, MD, FACR is a member of the following medical societies: American Association for Women Radiologists, American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Clinical Assistant Professor of Radiology, University of Washington Medical School
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

 
 
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