Al-Saadie Waddah
Otolaryngology Department, Damascus Hospital, Damascus, Syria.
Int J Surg Case Rep. 2025 Feb;127:110945. doi: 10.1016/j.ijscr.2025.110945. Epub 2025 Jan 25.
Cystic hygroma is a benign lymphatic malformation, developing around 6th gestational week. The big challenge is in the way they are managed due to their extension within the vital elements. Treatment options include watchful waiting, surgery, sclerotherapy and combination between them in some cases.
We present a rare case of giant cystic hygroma of a 11-month-old male was referred to the Department of Otolaryngology for an asymptomatic, aesthetically unappealing swelling in the neck since 9 months. A well-defined large cystic mass measures about (4 × 7 × 9 cm) was seen in the CT scan, originating at the left lateral neck. It extends from the left submandibular space inferiorly posterior to the sternocleidomastoid muscle, and retrosternally to the aortic arch level. From the Posterior aspect, the mass reaches the prevertebral space. No lymph adenopathy was noted. No bony erosions. Findings are suggestive of Cystic Higroma (CH).The primary treatment was sclerotherapy using doxycycline for one time. The procedure was performed at an operating theatre under general anesthesia because injection of the sclerosant factor is painful. The child was monitored for 3 months after the procedure (with an interval of one month between each observation). There was a noticeable improvement after 4 weeks and the complete resolution of the cystic hygroma was observed 12 weeks after the initial procedure. During the monitoring period of 6 months, the lesion did not show any recurrence.
In this case of giant Cystic Higroma (CH) significantly decreased after using of Doxycycline sclerotherapy for one time only without the need to repeat the procedure more than once. So clinicians should be aware of this good treatment of (CH) because it offers minimal patient trauma and excellent outcomes.
Through the good results we have reached from this case, we encourage its application extensively in the future to more cases due to their safety and quick results.
囊状水瘤是一种良性淋巴管畸形，在妊娠第6周左右形成。由于其在重要结构内的延伸，对其治疗是一项巨大挑战。治疗选择包括密切观察、手术、硬化治疗，在某些情况下还包括它们之间的联合应用。
我们报告一例罕见的11个月大男性巨大囊状水瘤病例，自9个月大起因颈部无症状但外观不佳的肿胀被转诊至耳鼻喉科。CT扫描显示一个边界清晰的大囊性肿块，大小约为（4×7×9厘米），起源于左侧颈部。它从左下颌下间隙向下延伸至胸锁乳突肌后方，胸骨后至主动脉弓水平。从后面看，肿块延伸至椎前间隙。未发现淋巴结肿大。无骨质侵蚀。检查结果提示为囊状水瘤（CH）。主要治疗方法是使用强力霉素进行一次硬化治疗。该操作在全身麻醉下于手术室进行，因为注射硬化剂会引起疼痛。术后对患儿进行了3个月的监测（每次观察间隔1个月）。4周后有明显改善，初次治疗12周后观察到囊状水瘤完全消退。在6个月的监测期内，病变未显示任何复发迹象。
在该例巨大囊状水瘤（CH）病例中，仅使用一次强力霉素硬化治疗后明显缩小，无需重复该操作。因此，临床医生应了解这种对（CH）的良好治疗方法，因为它对患者的创伤最小且效果极佳。
通过该病例取得的良好结果，我们鼓励未来因其安全性和快速疗效而在更多病例中广泛应用。
