Imaging features, complications and differential diagnoses of abdominal cystic lymphangiomas
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REVIEW
Imaging features, complications and differential diagnoses of abdominal cystic lymphangiomas M. Raufaste Tistet1 · O. Ernst1 · M. Lanchou1 · M. Vermersch1 · P. Lebert1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose The aim of the study is to describe the imaging features, complications and differential diagnoses of abdominal cystic lymphangiomas (ACLs). Results ACLs are benign lymphatic malformations that mainly arise in the subperitoneal space and the retroperitoneum. The typical presentation of an ACL is a multilocular lesion with homogenous serous content, presenting a thin wall and septa, usually free from adjacent organ compression. Atypical findings, including fat or hemorrhagic content, septal calcifications and unilocular presentation, are not uncommon. Rarely, ACLs can be revealed by acute complications, such as infection, hemorrhage, intussusception, complications with a twisting mechanism (including torsion around its own pedicle) or spontaneous rupture, which can be diagnosed by imaging. Ultrasonography and CT are the most useful modalities in emergency situations. MRI performs best in the noninvasive characterization of cystic lesions. ACLs should be differentiated from normal anatomic structures (e.g., cisterna chyli) or pitfalls (e.g., ascites, extrapancreatic necrosis, lymphocele) that can simulate ACLs. Among other primary peritoneal cystic lesions, benign cystic mesothelioma can be difficult to differentiate from ACL. Some neoplastic peritoneal lesions may have cystic components or content that looks like fluid on imaging (such as mucinous or myxoid content) and be misdiagnosed as ACL. Nodular or thick enhancement of the wall or septa should then be considered worrisome features and should not suggest ACL. ACLs mostly require a simple follow-up. If treatment is necessary, percutaneous sclerotherapy is a safe and effective alternative to surgery. Conclusion Imaging, especially MRI, allows the noninvasive diagnosis of ACL and helps to exclude potential malignant differential diagnoses. Keywords Computed tomography · Cystic peritoneal lesions · Lymphangioma · cystic · Magnetic resonance imaging · Ultrasonography Abbreviations ACL Abdominal cystic lymphangioma CT Computed tomography MRI Magnetic resonance imaging US Ultrasonography WI Weighted images
* M. Raufaste Tistet [email protected] 1
Department of Digestive Diagnostic and Interventional Radiology, University Hospital Claude Huriez – Regional University Hospital Center, rue Michel Polonoski, 59037 Lille Cedex, France
Introduction Cystic lymphangiomas are slow-growing benign lymphatic malformations [1] that rarely arise in the abdomen [2, 3]. Indeed, abdominal cystic lymphangiomas (ACLs) account for less than 5% of all cystic lymphangiomas, while their most common locations are the neck and axillary regions [2, 4]. Histologically, ACLs are made of thin-walled cystic dilatations of vascular channels lined by endothelial cells and filled with proteinaceous fluid [1, 5]. T
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