Tirushi Jain, Ashwani Kumar Dalal*, Usha Rani Dalal, Sarthak Aggrawal, Twinkle and Tejas Patil
Aim
Non traumatic lymphangiectatic cysts of the lymphatic system are rare developmental anomalies that can appear at any age or site. Mostly asymptomatic and benign, those located in neck and mediastinum can present with pressure symptoms and may become life threatening if gets infected or ruptured. Moreover, the complication of high output chylous fistula that may develop post operatively are also well known to occur and are important to manage promptly and aggressively as nutritional depletion and decrease in immunity are fast to occur thereafter. Conservative management includes nutritional and diet changes. There are no exact guidelines on the timing of surgical intervention.
Case Summary
We report a case 24 years old boy having lymphangiectatic cyst in superior mediastinum extending into the neck presenting with progressive dyspnoea. The cyst was excised under GA. Subsequently, thoracic duct ligation via video assisted thoracoscopic surgery on 11 post day was done in view of high output chylous fistula and he was discharged in satisfactory condition.
Conclusion
Important to keep lymphangiectatic cyst as a differential diagnosis in neck and mediastinum masses. The importance and timing of thoracic duct ligation is important to understand. Apart from the thoracic duct the possibility of additional draining lymphatic ducts into the cyst should be kept in mind.
