Cervicofacial Lymphangiomas Workup

Updated: Apr 13, 2016
  • Author: Ted L Tewfik, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Workup

Imaging Studies

See the list below:

  • Barium swallow and/or upper and lower GI series, when indicated

  • Chest radiography

  • Computed tomography

    • CT identifies a multiloculated cyst with smooth septa, which enhances uniformly after contrast injection.

    • CT fluid density ranges from -4 to 34 HU, depending on the lipid content and presence of blood.

    • CT contrast is unpredictable because enhancement occurs in only 50% of cases.

  • Magnetic resonance imaging: MRI is the study of choice in the evaluation of head and neck lymphangiomas.

  • Ultrasonography: For cervical lymphangiomas, the ultrasonogram depicts a cystic mass with smooth, thin, or irregular walls.

  • Arteriography: This study is indicated in cases in which a hemangioma, an arterial vascular (A/V) malformation, paragangliomas/glomus tumors, or vascular schwannomas are strongly suggested by means of conventional imaging studies.

  • Screening ultrasonography and MRI

    • Screening ultrasonography has been a valuable tool to evaluate for fetal abnormalities, such as cystic hygroma, diaphragmatic hernia, bronchopulmonary sequestration, fetal airway obstruction, and other life-threatening birth defects.

    • MRI is helpful to corroborate these findings and refine the diagnosis.

    • This combination of imaging techniques is also useful when evaluating the abdomen in children and adults.

  • Lymphoscintigraphy: This technique may help identify the source of lymph flow but is not available as a standard clinical study.

  • Nuclear magnetic imaging (NMR) and MRI

    • These imaging studies delineate lymphangiomas more accurately with excellent identification of extent because of T2-weighted sequences. Images on T2 have greater signal intensity than muscle, cerebrospinal fluid, and fat.

    • NMR is the study of choice before surgical excision.

    • Gadolinium adds no additional imaging characteristics.

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Other Tests

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  • Depending on the anatomic location, other diagnostic studies may include the following:

    • Full neuro-ophthalmic examination for orbital or central lesions

    • Laryngoscopy, bronchoscopy, and/or esophagoscopy for lesions of the upper aerodigestive system

    • Abdominal endoscopy and/or colonoscopy for lower GI lesions

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Diagnostic Procedures

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  • Slim-needle biopsy usually yields straw-colored fluid, not the cellular material necessary for histologic diagnosis.

  • Tissue diagnosis, as a direct and final correlate to imaging studies, is the best and most consistent confirmation of lymphangioma.

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Histologic Findings

Excluding simplex circumspecta, lymphangiomas may histopathologically be classified into 2 types—the cavernous type and the cystic type. However, histologic characteristics of both types are the usual finding. The cavernous variety tends to involve the lips, tongue, and floor of the mouth. On histologic examination, these masses are composed of dilated cystic spaces containing blood or lymph lined by endothelial cells with a scant-to-dense fibrous stroma. Cell types in the stroma include lymphocytes, lymphatic tissue, fat, or muscle. Spaces vary in size, from capillary to cavernous channels often resembling a Swiss-cheese pattern. Indiscreet margins with no encapsulation correlate with the gross appearance in lobulated cystic types, which have multiple fingerlike extensions into the surrounding tissue.

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