lymphatic cyst of the thoracic duct – a rare differential diagnosis of a swollen supraclavicular region

Introduction:

There are many different reasons of a swollen cervical supraclavicular region. This includes the common causes as swollen lymph nodes, haemtoma and inflammation but also surgical procedures, blunt traumas or neoplasms. Sometimes a cervical swelling can also be caused by a lympathic cyst of the thoracic duct.

Case:

We report about a 27- years old female with a persistent swelling of the supraclavicular region, which has grown since two weeks. Apart from a restriction of movement there were no symptoms. Surgical procedures or traumas were negated. The clinical examination shows a tight flexible up to 3 – 4 cm in size painless swelling without redness and overheating of the cervical region immediately above the sternoclavicular joint. To find the diagnosis we did a ultrasound and a magnetic resonance imaging. The laboratory results were normal. The MRI scan showed a cystic mass in the venous arch on the left side. The ultrasound confirmed a low-echo, sharply delimited and homogeneous result. In synopsis oft he findings we decided along with the patient to do a surgical removal. During the surgery resulted a cystical lesion with multiple lymphatic inflows which were strongly grown together with the venous arch. The post-operative recovery proceeded without complications, A CT scan three days after showed apart from a small pleural effusion regular local findings. Three months later the patient remained completely symptom-free.

Conclusion:

A lymphatic cyst oft he thoracic duct should also be considered in case of unclear swelling of the supraclavicular region. Therefore further diagnostic imaging is necessary. Afterwards surgical removal could be a therapeutic option.

Publication History

Publication Date:
18 April 2018 (online)