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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) TFE-DW 3T MR image in the axial plane showing the lesion (L) as a hypointense structure splaying the hyperintense right atrium (RA) and right ventricle (RV). (b) T1-weighted FSE of the heart in the axial plane showing the heterogenously hyperintense lesion (L) with internal septae within involving the anterior mediastinal region, centered on the atrioventricular groove between the right atrium (RA) and right ventricle (RV), with the right coronary artery (RCA) seen passing inside the lesion appearing as a signal void vessel. (c) T2-weighted TSE-BB 3T MR image of the heart showing the hyperintense lesion (L) abutting the right atrium (RA) and right ventricle (RV) which display a hypointense signal. The heterogenous intermediate-to-bright signal of the pericardial effusion (P) is seen at the right lateral aspect of the lesion
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Figure 2: (a) TFE-DW 3T MR image in the axial plane showing the lesion (L) as a hypointense structure splaying the hyperintense right atrium (RA) and right ventricle (RV). (b) T1-weighted FSE of the heart in the axial plane showing the heterogenously hyperintense lesion (L) with internal septae within involving the anterior mediastinal region, centered on the atrioventricular groove between the right atrium (RA) and right ventricle (RV), with the right coronary artery (RCA) seen passing inside the lesion appearing as a signal void vessel. (c) T2-weighted TSE-BB 3T MR image of the heart showing the hyperintense lesion (L) abutting the right atrium (RA) and right ventricle (RV) which display a hypointense signal. The heterogenous intermediate-to-bright signal of the pericardial effusion (P) is seen at the right lateral aspect of the lesion

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) TFE-DW 3T MR image in the axial plane showing the lesion (L) as a hypointense structure splaying the hyperintense right atrium (RA) and right ventricle (RV). (b) T1-weighted FSE of the heart in the axial plane showing the heterogenously hyperintense lesion (L) with internal septae within involving the anterior mediastinal region, centered on the atrioventricular groove between the right atrium (RA) and right ventricle (RV), with the right coronary artery (RCA) seen passing inside the lesion appearing as a signal void vessel. (c) T2-weighted TSE-BB 3T MR image of the heart showing the hyperintense lesion (L) abutting the right atrium (RA) and right ventricle (RV) which display a hypointense signal. The heterogenous intermediate-to-bright signal of the pericardial effusion (P) is seen at the right lateral aspect of the lesion
© Copyright Policy - open-access
Related In: Results  -  Collection

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Show All Figures
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Figure 2: (a) TFE-DW 3T MR image in the axial plane showing the lesion (L) as a hypointense structure splaying the hyperintense right atrium (RA) and right ventricle (RV). (b) T1-weighted FSE of the heart in the axial plane showing the heterogenously hyperintense lesion (L) with internal septae within involving the anterior mediastinal region, centered on the atrioventricular groove between the right atrium (RA) and right ventricle (RV), with the right coronary artery (RCA) seen passing inside the lesion appearing as a signal void vessel. (c) T2-weighted TSE-BB 3T MR image of the heart showing the hyperintense lesion (L) abutting the right atrium (RA) and right ventricle (RV) which display a hypointense signal. The heterogenous intermediate-to-bright signal of the pericardial effusion (P) is seen at the right lateral aspect of the lesion
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