Retroperitoneal lymphangioma in an adult

Clinical History

A 42-year-old female patient with abdominal pain and distension.

Imaging Findings

The radiography shows opacity of soft tissue density in left abdomen that displaces the intestinal loops (Fig. 1)
Abdominal CT shows a hypoattenuating cystic mass in the left retroperitoneal space, the ascending colon is displaced anteriorly (arrow), the small bowel loops are displaced to the right side. (Fig. 2)
Axial non-enhanced and contrast-enhanced abdominal CT shows hyperdense material in the cystic mass, no enhancement was seen with intravenous contrast (arrow). (Fig. 3)
T1-weighted image shows hypointense cystic mass with hyperintense and hypointense dependent parts suggestive of haemorrhage. (Fig. 4)
T2-weighted image shows hyperintense cystic mass (arrow) located in the left retroperitoneal space.

Discussion

Lymphangiomas are benign congenital tumours that arise as a result of sequestration of embryonic lymphatic vessels that have failed to communicate with the rest of the lymphatic or venous system [1]. Up to 95% of lymphangiomas occur in the neck and axillary region, and most patients are children [2, 3]. Intraabdominal lymphangiomas are rarely reported in adults, less than 1% of all lymphangiomas occur in the retroperitoneum [4, 5]. They can be of capillary, cavernous, or cystic type [2, 3]. Most cystic lymphangiomas occur in the head or neck; a retroperitoneal location is unusual.
Clinically, lymphangiomas are often asymptomatic but may manifest due to pressure symptoms or as a palpable mass [1].
At CT, cystic lymphangioma typically appears as a large, thin-walled, multiseptate cystic mass [6, 7]. Its attenuation values vary from that of fluid to that of fat. An elongated shape and a crossing from one retroperitoneal compartment to an adjacent one are characteristic of the mass [6].
At MR imaging, they appear as uni or multilocular areas of low T1 and high T2. Signal intensity corresponds to cystic spaces with thin, almost imperceptible walls. No significant enhancement is seen following the administration of gadolinium-based contrast material. One of the characteristic imaging features of lymphangioma is its ability to cross from one compartment to another, reflecting the pathway of developing lymphatic vessels [1].
The treatment of choice is complete surgical resection in order to avoid recurrences or complications.

Differential Diagnosis List

Final Diagnosis

Retroperitoneal lymphangioma in an adult

URL:	https://www.eurorad.org/case/14413
DOI:	10.1594/EURORAD/CASE.14413
ISSN:	1563-4086