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Imaging of pericardial lymphangioma.

Zakaria RH, Barsoum NR, El-Basmy AA, El-Kaffas SH - Ann Pediatr Cardiol (2011)

Bottom Line: Pericardial cystic lymphangioma is a developmental malformation of the lymphatic system.We report a case of cystic pericardial lymphangioma in the anterior mediastinum in a 1-year-old male child.Histopathological examination showed features of cystic lymphangioma.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Faculty of Medicine, Cairo University, Giza, Egypt.

ABSTRACT
Pericardial cystic lymphangioma is a developmental malformation of the lymphatic system. We report a case of cystic pericardial lymphangioma in the anterior mediastinum in a 1-year-old male child. The lesion was diagnosed with multidetector computed tomography and magnetic resonance imaging (MRI). Histopathological examination showed features of cystic lymphangioma.

No MeSH data available.


Related in: MedlinePlus

(a) Volume-rendered MSCT image showing the site of the lesion centered on the AV groove, splaying the right atrium (RA) and right ventricle (RV) and slightly compressing them and the origin of the main pulmonary artery (PA). It also demonstrates the right coronary artery (RCA) originating from the aorta (AO) and passing into the site of the lesion without alteration of its course. (b) MSCT image of the heart in the axial plane after contrast administration showing the partially heterogenous hypodense lesion (L) involving the anterior mediastinal region, splaying the right atrium (RA) and right ventricle (RV), with the right coronary artery (RCA) seen arising from the aorta (AO) and passing anteriorly traversing the lesion. It also shows that the lesion is deep within the pericardium (P) with pericardial effusion
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Figure 1: (a) Volume-rendered MSCT image showing the site of the lesion centered on the AV groove, splaying the right atrium (RA) and right ventricle (RV) and slightly compressing them and the origin of the main pulmonary artery (PA). It also demonstrates the right coronary artery (RCA) originating from the aorta (AO) and passing into the site of the lesion without alteration of its course. (b) MSCT image of the heart in the axial plane after contrast administration showing the partially heterogenous hypodense lesion (L) involving the anterior mediastinal region, splaying the right atrium (RA) and right ventricle (RV), with the right coronary artery (RCA) seen arising from the aorta (AO) and passing anteriorly traversing the lesion. It also shows that the lesion is deep within the pericardium (P) with pericardial effusion

Mentions: A 1-year-old child was suffering from recurrent episodes of cough and expectoration, and had progressively worsening respiratory distress. His chest X-ray was normal, and a single-slice post-contrast computed tomographic (CT) examination revealed an anterior mediastinal cyst, which showed no enhancement on CT. An attempt at surgical removal at another centre had to be abandoned due to severe bleeding and the patient was referred to our centre for a complete diagnostic work up. A 64 slice multidetector CT (MDCT) angiography was performed using ECG gated acquisition. The acquired volumetric data were used to reconstruct multiplanar reformatted (MPR) images, maximal intensity projections (MIP), and volume rendering (VR) images [Figure 1a]. The study revealed a huge well-circumscribed lesion centered along the right atrioventricular groove. The right atrium was seen to be compressed and splayed along the posterior border of the lesion. The right ventricle was also splayed along the anterior border of this huge lesion. The lesion measured about 5 × 4.8 × 6 cm in its maximum transverse, anteroposterior, and craniocaudal diameters, respectively. It appeared hypodense with no contrast opacification within, yet with the residual enhancing wall. The right coronary artery (RCA) was seen splayed at its origin at the upper border of the lesion with some of its branches seen passing through the lesion [Figure 1b]. No definite extensions of this lesion into the right atrial or right ventricular cavities could be detected. Associated pericardial thickening and encysted right-sided pericardial effusion were also noted. High-field 3-T magnetic resonance imaging (MRI) was then performed in the axial and sagittal views using T1, T2 turbo spin echo (TSE), balanced turbo field echo (BTFE), and turbo field echo - diffusion weighted (TFE-DW) sequences. This confirmed the CT findings and the soft tissue mass elicited a heterogeneous hyperintense signal in T1 WI with an intense bright pattern on T2WI, showing internal intermediate heterogenous septae [Figure 2a]. It abutted the anterior aspect of the right ventricle and atrium; both were compressed with an indistinct plane of cleavage between the mass and cardiac muscle. The right coronary artery and its branches were seen traversing the lesion likely encased by this soft tissue, predominantly cystic, lesion [Figure 2b] and encysted pericardial effusion was seen [Figure 2c]. By means of these two advanced diagnostic modalities, we were able to reach a diagnosis of a multilocular cystic lesion mostly pericardial in location, intimately related to the right atrioventricular groove apparently inseparable from the cardiac muscle. The patient was then readmitted for surgery where the tumor was indeed identified as a multilocular cystic lesion that bled profusely, and also oozed lymphatic contents upon its incision; it was removed carefully with a safety margin, with careful extraction of the coronary artery and its branches. A small tumoral component was seen extending into the right atrial myocardial tissue, which could not be surgically excised. The tumor was then sent for histopathological evaluation revealing a cystic cardiac lymphangioma [Figure 3]. The postoperative course was uneventful. The patient is asymptomatic and without recurrence 5 months postoperatively.


Imaging of pericardial lymphangioma.

Zakaria RH, Barsoum NR, El-Basmy AA, El-Kaffas SH - Ann Pediatr Cardiol (2011)

(a) Volume-rendered MSCT image showing the site of the lesion centered on the AV groove, splaying the right atrium (RA) and right ventricle (RV) and slightly compressing them and the origin of the main pulmonary artery (PA). It also demonstrates the right coronary artery (RCA) originating from the aorta (AO) and passing into the site of the lesion without alteration of its course. (b) MSCT image of the heart in the axial plane after contrast administration showing the partially heterogenous hypodense lesion (L) involving the anterior mediastinal region, splaying the right atrium (RA) and right ventricle (RV), with the right coronary artery (RCA) seen arising from the aorta (AO) and passing anteriorly traversing the lesion. It also shows that the lesion is deep within the pericardium (P) with pericardial effusion
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3104538&req=5

Figure 1: (a) Volume-rendered MSCT image showing the site of the lesion centered on the AV groove, splaying the right atrium (RA) and right ventricle (RV) and slightly compressing them and the origin of the main pulmonary artery (PA). It also demonstrates the right coronary artery (RCA) originating from the aorta (AO) and passing into the site of the lesion without alteration of its course. (b) MSCT image of the heart in the axial plane after contrast administration showing the partially heterogenous hypodense lesion (L) involving the anterior mediastinal region, splaying the right atrium (RA) and right ventricle (RV), with the right coronary artery (RCA) seen arising from the aorta (AO) and passing anteriorly traversing the lesion. It also shows that the lesion is deep within the pericardium (P) with pericardial effusion
Mentions: A 1-year-old child was suffering from recurrent episodes of cough and expectoration, and had progressively worsening respiratory distress. His chest X-ray was normal, and a single-slice post-contrast computed tomographic (CT) examination revealed an anterior mediastinal cyst, which showed no enhancement on CT. An attempt at surgical removal at another centre had to be abandoned due to severe bleeding and the patient was referred to our centre for a complete diagnostic work up. A 64 slice multidetector CT (MDCT) angiography was performed using ECG gated acquisition. The acquired volumetric data were used to reconstruct multiplanar reformatted (MPR) images, maximal intensity projections (MIP), and volume rendering (VR) images [Figure 1a]. The study revealed a huge well-circumscribed lesion centered along the right atrioventricular groove. The right atrium was seen to be compressed and splayed along the posterior border of the lesion. The right ventricle was also splayed along the anterior border of this huge lesion. The lesion measured about 5 × 4.8 × 6 cm in its maximum transverse, anteroposterior, and craniocaudal diameters, respectively. It appeared hypodense with no contrast opacification within, yet with the residual enhancing wall. The right coronary artery (RCA) was seen splayed at its origin at the upper border of the lesion with some of its branches seen passing through the lesion [Figure 1b]. No definite extensions of this lesion into the right atrial or right ventricular cavities could be detected. Associated pericardial thickening and encysted right-sided pericardial effusion were also noted. High-field 3-T magnetic resonance imaging (MRI) was then performed in the axial and sagittal views using T1, T2 turbo spin echo (TSE), balanced turbo field echo (BTFE), and turbo field echo - diffusion weighted (TFE-DW) sequences. This confirmed the CT findings and the soft tissue mass elicited a heterogeneous hyperintense signal in T1 WI with an intense bright pattern on T2WI, showing internal intermediate heterogenous septae [Figure 2a]. It abutted the anterior aspect of the right ventricle and atrium; both were compressed with an indistinct plane of cleavage between the mass and cardiac muscle. The right coronary artery and its branches were seen traversing the lesion likely encased by this soft tissue, predominantly cystic, lesion [Figure 2b] and encysted pericardial effusion was seen [Figure 2c]. By means of these two advanced diagnostic modalities, we were able to reach a diagnosis of a multilocular cystic lesion mostly pericardial in location, intimately related to the right atrioventricular groove apparently inseparable from the cardiac muscle. The patient was then readmitted for surgery where the tumor was indeed identified as a multilocular cystic lesion that bled profusely, and also oozed lymphatic contents upon its incision; it was removed carefully with a safety margin, with careful extraction of the coronary artery and its branches. A small tumoral component was seen extending into the right atrial myocardial tissue, which could not be surgically excised. The tumor was then sent for histopathological evaluation revealing a cystic cardiac lymphangioma [Figure 3]. The postoperative course was uneventful. The patient is asymptomatic and without recurrence 5 months postoperatively.

Bottom Line: Pericardial cystic lymphangioma is a developmental malformation of the lymphatic system.We report a case of cystic pericardial lymphangioma in the anterior mediastinum in a 1-year-old male child.Histopathological examination showed features of cystic lymphangioma.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Faculty of Medicine, Cairo University, Giza, Egypt.

ABSTRACT
Pericardial cystic lymphangioma is a developmental malformation of the lymphatic system. We report a case of cystic pericardial lymphangioma in the anterior mediastinum in a 1-year-old male child. The lesion was diagnosed with multidetector computed tomography and magnetic resonance imaging (MRI). Histopathological examination showed features of cystic lymphangioma.

No MeSH data available.


Related in: MedlinePlus