‘A huge congenital cervical lymphangioma’ – Case report with review of literature

Lymphangiomas are rare congenital malformations of the lymphatic system that can appear at any age or site. In majority they are diagnosed at birth and 95% of them are found in the neck, the head, or the axilla. Although benign, and commonly asymptomatic, they can sometimes cause pressure and life threatening complications especially massive lesions involving the neck and mediastinum in newborn infants or cause a diagnostic confusion as a result of sudden enlargement following haemorrhage or infection. Lymphangiomas frequently present surgical difficulties and challenges due to their propensity to infiltrate and extend around neighbouring structures. We report a newborn who presented with a huge congenital cervical swelling involving upper 2/3rd of neck on both sides since birth. Complete surgical excision of the lesion was achieved, without damaging any vital structures. After 9 months of surgery, following an episode of upper respiratory tract infection the child developed a large cystic swelling over the lower 1/3rd of neck. Complete surgical excision of the lesion was done. The final histopathological diagnosis was lymphangioma. One year of further follow up showed a cosmetically acceptable scar and no recurrence was noted. The literature is reviewed and the presentation and management of lymphangiomas are discussed.