Percutaneous Lauromacrogol Foam Sclerotherapy for the Treatment of Acute Airway Compression Caused by Lymphatic Malformations in Infants.

Lidan Wang,Fan Liu,Sui Huang

doi:10.1155/2018/3878960

Lidan Wang, Fan Liu + Show 1 more

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https://doi.org/10.1155/2018/3878960

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Abstract

Management of LMs still remains a challenge especially for those suffering from complications such as acute airway compression. In this study, we retrospectively evaluated the efficacy and safety of percutaneous lauromacrogol foam sclerotherapy for the patients with acute airway compression caused by lymphatic malformations (LMs) in infants. Five cases of infants with acute airway compression caused by LMs were treated with lauromacrogol foam sclerotherapy in the radiology department from February 2013 to August 2015 at Wuhan Medical and Healthcare Center for Women and Children, China. By CT examination and the DSA imaging, LMs were diagnosed and progressed cervical and sublingual LMs combined with hemorrhages were observed and suppression of the trachea was noticed as well, resulting in the difficulty with breathing and feeding. For all the patients, we extracted most cyst liquid from the LMs to reduce the surface tension and alleviate the respiratory pressure symptoms under the guidance of ultrasound. Subsequently, the lauromacrogol foam was injected percutaneously into the cyst of LMs. The dose of the agent was determined according to the size of the LMs, which was 3-8 ml in our study. After treatment, autonomous respiration and independent eating were observed. When the procedures were completed after 16 cycles, the cyst cavity became atrophic and then nearly vanished. During the follow-up period (a minimum of three months and a maximum of two years), 4 patients were clinically proved to be cured and one patient was significantly improved. There was no recurrence, serious complications, or adverse reactions. Our study demonstrated that percutaneous sclerotherapy combined with lauromacrogol foam is a safe, effective therapy for acute airway compression caused by LMs, especially giving a good cosmetic result.

Highlights

Lymphatic malformations (LMs) are considered to be a benign vascular lesion that arises from embryological disturbances in lymphatic system development
Four patients suffered from difficulty with breathing as the airway was suppressed by the accelerated enlargement of LM, of which three patients showed unstable vital signs, dyspnea, and the decreased heart rate that required cardiopulmonary resuscitation and endotracheal intubation respirator-assisted ventilation
Intralymphatic hemorrhage, infection, or trauma may lead to acute LM expansion and airway obstruction occasionally when the deep neck space is involved [8]

Summary

Introduction

Lymphatic malformations (LMs) are considered to be a benign vascular lesion that arises from embryological disturbances in lymphatic system development. It can be found in any anatomic region and is more obvious in lymphaticrich areas such as the head and neck (45–52%), axilla, mediastinum, groin, and retroperitoneum [1]. According to disease type and scope of lesions, one way or combination of several methods can be considered. The LM located at the neck is still challenging for the physician due to its complicated anatomical relationship among the surrounding vital tissues such as airway and nerves. A novel strategy by using a simple and safe procedure to preserve the normal anatomical structure around the lesion is worthy of evaluation

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