Mesenteric cystic lymphangioma

Clinical History

A 3 year old boy was admitted to the department of paediatric surgery with abdominal pain and vomiting. Past medical history was unremarkable.
Physical examination revealed abdominal tenderness without signs of peritonitis and without fever. Clinically partial bowel obstruction was suspected. Abdominal US and CT were performed.

Imaging Findings

Abdominal US (not shown)

US revealed large, cystic mass with thin septa located in left epigastric, umbilical and hypogastric region of abdomen. Fluid within the mass was anechoic without internal echoes. Origin of the cystic mass was hard to define on US examination.

CT

In the left epigastric, umbilical and hypogastric region of the abdomen, CT demonstrated a large well-defined mesenteric cystic mass -165x155x80 mm in size.
Within the mass thin septa were visible. The density of the fluid within the lesion was 8-10 HU. After contrast administration moderate enhancement of walls and septa was achieved.
The mass moved and compressed the intestinal loops.

Complete surgical excision with resection of the part of small bowel was performed and end-to-end anastomosis followed.

Discussion

The most common type of mesenteric or omental cyst is lymphangioma, but other types encountered include the enteric duplication cyst, the enteric cyst, the mesothehal cyst, and the nonpancreatic pseudocyst. The major role of the radiologist is to document the cystic nature of these abdominal masses and their mesenteric or omental origin [1].
Lymphangioma is a congenital malformation of the lymphatic vessels that occasionally occurs in the mesentery. [1] Lymphangioma may arise within the small bowel mesentery, the mesocolon, or peritoneal reflections [2] Lack of communication of small bowel lymphatic tissue with lymphatic vessels results in cystic mass formation that may be large enough to produce symptoms of partial bowel obstruction. [1]
Most cases are asymptomatic except when complicated. Intestinal obstruction is a rarely reported complication of these cysts.[3] They can present themselves as chronic abdominal pain, an abdominal mass, and abdominal pain, and the most common physical finding is an abdominal mass which is movable transversely but not longitudinally [4]
At CT, cystic lymphangioma typically appears as a large, thin-walled, multiseptate cystic mass. Its attenuation values vary from that of fluid to that of fat. [5] Occasionally, the walls may be thick and irregular. The fluid contents are usually homogeneous. [2] An elongated shape and a crossing from one retroperitoneal compartment to an adjacent one are characteristic of the mass. Rarely, cystic lymphangiomas may have wall calcification. [5]
Surgical excision is the treatment of choice. [5] Lymphangiomas can be intimately attached to the bowel wall, requiring bowel resection for their removal. [1]

Differential Diagnosis List

Final Diagnosis

Mesenteric cystic lymphangioma

URL:	https://www.eurorad.org/case/12978
DOI:	10.1594/EURORAD/CASE.12978
ISSN:	1563-4086