Left cervical swelling due to lymphatic intraluminal obstruction.

Abstract

A 42-year-old woman had presented to the outpatient clinic because of a swelling of the left cervical region. Her medical history was remarkable for multiyear episodes of recurrent cervical swelling with abdominal pain that always regressed spontaneously. The physical examination showed a soft nontender mass in the left supraclavicular fossa without pain or skin redness (A). Magnetic resonance lymphography (B) without contrast injection showed a marked dilation of the thoracic duct (arrowhead). We also visualized a dilation of the cervical lymphatic duct network (long arrow). The terminal part of the thoracic duct showed a segmental dilation ≤13 mm with visualization of lymphatic intraluminal obstruction (LIO; short arrows). Ultrasound examination (C) focused on this area confirmed the LIO of the terminal portion of the thoracic duct. No other lymphatic or vascular malformations were demonstrated by thoracoabdominal computed tomography or magnetic resonance imaging. One week later, the patient had recovered uneventfully with complete resorption of the cervical swelling. Because the cervical swelling had spontaneously resolved, surgery was not considered.1Veziant J. Sakka L. Galvaing G. Tardy M.M. Cassagnes L. Filaire M. Lymphovenous anastomosis for recurrent swelling syndrome and chylous effusion due to cervical thoracic duct cyst.J Vasc Surg. 2015; 62: 1068-1070Google Scholar A supraclavicular mass can arise from infectious disease, a branchial clef cyst, or a benign or malignant tumor. LIO of the thoracic duct is a rare condition that can cause recurrent swelling of the cervical region.2Kunze G. Staritz M. Lymph vessel thrombus detection in cervical lymphedema: a case series.J Ultrasound Med. 2017; 36: 1955-1960Google Scholar Magnetic resonance lymphography without contrast media injection allows for easy visualization of the lymphatic duct network and can directly demonstrate the LIO without the need to inject contrast media.3Cholet C. Delalandre C. Monnier-Cholley L. Le Pimpec-Barthes F. El Mouhadi S. Arrivé L. Nontraumatic chylothorax: nonenhanced MR lymphography.Radiographics. 2020; 40: 1554-1573Google Scholar,4Arrivé L. Derhy S. El Mouhadi S. Monnier-Cholley L. Menu Y. Becker C. Noncontrast magnetic resonance lymphography.J Reconstr Microsurg. 2016; 32: 80-86Google Scholar The patient gave her written informed consent for the report of her case details and imaging studies.