Figures
- Figure 1
a–c) CT images demonstrating the mostly thin-walled, pleural-based, cavitary lesion in the periphery of the RML.
- Figure 2
CT demonstrating the low density enlarged right hilar lymph node. Similar appearing nodes were also present elsewhere in the mediastinum.
- Figure 3
Lack of FDG activity in the cavitary lesion on a fused PET/CT image.
- Figure 4
Pathology slide from pulmonary resection showing multiple, cystically dilated lymphatic spaces surrounded by a reactive myofibroblastic proliferation, abundant haemosiderin and scattered granulomas. Large, abnormal collateral pleural vessels were present, intermixed with the lymphangioma and resulting in a sizable pleural adhesion to the chest wall.
- Figure 5
a–c) Immunostaining for CD31 and D2-40 confirmed the lymphatic nature of the cystic spaces, and the surrounding myofibroblastic reaction was negative for HMB-45, excluding lymphangioleiomyomatosis.
- Figure 6
Lymph node resection depicting lymphangioma within the lymph node.
- Figure 7
a–c) Convex probe EBUS images of subcarinal station showing ill-defined margins, heterogeneous consistency and absence of central blood vessels. Note the absence of Doppler flow signal.
Tables
- Table 1
Clinical characteristics of lymphangiomas and differential diagnosis
Age at presentation Childhood (90% <2 years-old) Aetiology Congenital
Acquired when in the context of chronic lymphatic obstruction due to chronic infection, radiation therapy or traumaSex predilection None in early diagnosis, female when diagnosed in adults Thoracic manifestations Intrapulmonary mass
Mediastinal mass (equal distribution among compartments)
Chylous pleural or chylous pericardial effusionExtrathoracic manifestations Head, neck, axilla, abdomen, bones Classification Capillary or simple, cavernous, cystic Natural history No spontaneous resolution
Secondary infections may occurDifferential diagnosis [9] Lymphangiectasis (primary or secondary)
Lymphangiomatosis
Lymphatic dysplasia syndromes (e.g. lymphedema, yellow nail syndrome)
Lymphangiosarcoma
Acquired lymphatic injuries (e.g. traumatic)
Other lymphatic abnormalities (e.g. lymphangioleiomyomatosis, lymphangiolipomas, haemangiolymphangiomas)
