Head and Neck Imaging

Lymphangioma, head and neck

(also called lymphatic vascular malformation). This is not a tumour, but malformations presenting in diverse forms, ranging from small mucosal or cutaneous blebs to large multilocular lesions. The cystic variety is often called cystic hygroma head and neck or 'cavernous lymphangioma'. Lymphangiomas may be mixed with blood-filled spaces (in these cases, they are called 'mixed', 'lymphatic-venous' or 'venouslymphatic' vascular malformations).

The cervicofacial region is a common location. Lymphatic malformation is a common reason for soft tissue and/or skeletal hypertrophy. The natural history of these lesions is proportional growth with the child.

These lesions appear on CT images as low-density, infiltrating lesions, surrounding or invading muscles, salivary glands and neurovascular structures. On MRI, they show high signal on T2-weighted images and low signal on T1-weighted images (Fig.1). The attenuation (on CT) or signal intensity (on MRI) may change after infection or intralesional bleeding.

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Fig.1

Three-year-old child presenting with intermittent swelling of the tongue and neck. Large soft tissue masses are seen bilaterally in the parotid region, parapharyngeal space and posterior cervical triangle. The lesions appear very bright on the axial T2-weighted spin-echo image (a) and do not show (apart from thin septal structures) contrast enhancement on the T1-weighted image (b). Similar lesions are seen in the floor of the mouth and the root of the tongue.
Lymphangioma, head and neck, Fig.1 (a)
Lymphangioma, head and neck, Fig.1 (b)