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A four-week-old, full-term male infant presented with a mass at the base of his neck (Panel A). The growth of the lesion, evident since his birth after an uncomplicated pregnancy, had been commensurate with the growth of the infant. Physical examination revealed a soft, well-defined, nontender mass in the neck measuring 11 by 8 cm. No abnormality was noted in the overlying skin. Application of a light source to the mass revealed complete transillumination (Panel B), which is consistent with the diagnosis of a macrocystic lymphatic malformation.
Macrocystic lymphatic malformations, also called cystic hygromas, occur most often at the base of the neck, in the axillary area, or along the side of the torso. They are almost always noted at birth and present as painless, well-circumscribed masses; the overlying skin appears normal. Transillumination is highly characteristic of this type of cystic malformation. Once the diagnosis is confirmed by radiographic studies, management options include sclerotherapy (which was used in this case) and surgical resection for cosmetic and functional problems.
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