An unusual case of adult airway obstruction from a lymphatic/venous malformation

Abstract

Objectives: Lymphatic, venous and mixed lymphovenous malformations are low-flow lesions that are present at birth and become clinically apparent before the age of 2 in 90% of cases. This case report puts forth an unusual presentation of a lymphovenous malformation in an adult. Methods: This is a case report of an unusual lymphovenous malformation. Results: A 19-year-old male presented to the emergency department with a 4-day history of worsening left sided odynophagia, fever, and voice changes. Exam revealed a left peritonsillar bulge consistent with a peritonsillar abscess; however, needle aspiration was negative. He was admitted for intravenous antibiotics, and over the ensuing 24 hours, his upper airway became acutely compromised. He was taken to the operating room emergently where he underwent an awake tracheotomy. Subsequent MRI revealed a large, poorly circumscribed heterogeneous left parapharyngeal mass that was isointense on T1 and hyperintense on T2 images consistent with a venous/lymphatic malformation. His lesion regressed after a course of steroids and antibiotics, and he was subsequently decannulated. Follow-up MRI shows marked reduction in the bulk of the lesion. Conclusion: A majority (70%-80%) of lymphatic and venous malformations present in the head and neck, primarily before 2 years of age. Rapid enlargement is common with trauma, spontaneous internal hemorrhage, or secondary infection, which is the likely scenario in our case. Treatment usually consists of sclerotherapy and/or surgical resection; however, the location and microcystic nature of our patient’s lesion was not amenable to these modalities. He remains asymptomatic over a year after his hospitalization.