title: Childhood abdominal cystic lymphangioma.
abstract: BACKGROUND
  Abdominal lymphangioma is a rare benign congenital malformation of the mesenteric and/or retroperitoneal lymphatics. Clinical presentation is variable and may be misleading; therefore, complex imaging studies are necessary in the evaluation of this condition. US and CT have a major role in the correct preoperative diagnosis and provide important information regarding location, size, adjacent organ involvement, and expected complications.
  
  
  OBJECTIVE
  To evaluate the clinical and imaging findings of seven children with proven abdominal cystic lymphangioma.
  
  
  METHODS
  Clinical and imaging files of seven children with pathologically proven abdominal lymphangioma, from three university hospitals, were retrospectively evaluated. Patient's ages ranged from 1 day to 6 years (mean, 2.2 years). Symptoms and signs included evidence of inflammation, abnormal prenatal US findings, chronic abdominal pain, haemorrhage following trauma, clinical signs of intestinal obstruction, and abdominal distension with lower extremities lymphoedema. Plain films of five patients, US of six patients and CT of five patients were reviewed. Sequential imaging examinations were available in two cases.
  
  
  RESULTS
  Abdominal plain films showed displacement of bowel loops by a soft tissue mass in five of six patients, two of them with dilatation of small bowel loops. US revealed an abdominal multiloculated septated cystic mass in five of six cases and a single pelvic cyst in one which changed in appearance over 2 months. Ascites was present in three cases. CT demonstrated a septated cystic mass of variable sizes in all available five cases. Sequential US and CT examinations in two patients showed progressive enlargement of the masses, increase of fluid echogenicity, and thickening of walls or septa in both cases, with multiplication of septa in one case. At surgery, mesenteric lymphangioma was found in five patients and retroperitoneal lymphangioma in the other two.
  
  
  CONCLUSIONS
  US and CT are highly sensitive in the diagnosis of abdominal lymphangioma. Our limited experience with follow-up examinations in two patients suggests that progressive enlargement, multiplication and thickening of septa and increased echogenicity of the cystic fluid are signs indicating complications demanding urgent treatment.
authors.affiliation: Department of Diagnostic Imaging, Meir General Hospital, Sapir Medical Centre, Kfar Saba 44281, Israel. rathaus@bezeqint.net
authors.forename: Osnat
authors.initials: O
authors.lastname: Konen
authors.forename: Valeria
authors.initials: V
authors.lastname: Rathaus
authors.forename: Elena
authors.initials: E
authors.lastname: Dlugy
authors.forename: Enrique
authors.initials: E
authors.lastname: Freud
authors.forename: Ada
authors.initials: A
authors.lastname: Kessler
authors.forename: Myra
authors.initials: M
authors.lastname: Shapiro
authors.forename: Gadi
authors.initials: G
authors.lastname: Horev
mesh_terms: D000008:Abdominal Neoplasms / Q000175:diagnosis*; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018191:Lymphangioma, Cystic / Q000175:diagnosis*; D008297:Male; D008643:Mesentery / Q000473:pathology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography