Multiloculated Cervical Lymphangioma Associated With Periventricular Leukomalacia In A 4-Year-Old Child: A Case Report

Abstract

Background: Congenital cervical masses in children, such as lymphangiomas, pose diagnostic and treatment challenges due to their anatomical complexity and diverse presentations. Commonly found in the head and neck, these benign malformations rarely coexist with neurological conditions like periventricular leukomalacia (PVL), a white matter brain injury linked to perinatal hypoxia, further complicating clinical assessment and management. Case Presentation: This report describes a 4-year-old child with a chronic, non-tender swelling on the left side of the neck. MRI imaging revealed a multiloculated, T2 hyperintense lesion with internal septations in the left submandibular region, consistent with a lymphangioma. A secondary, similar lesion was found at the left thoracic inlet. Concurrent MRI brain findings demonstrated bilateral periventricular hyperintensities in the posterior corona radiata, confirming PVL. The child had a history of birth hypoxia and exhibited global developmental delays. Diagnostic Assessment: The diagnosis was supported by fine needle aspiration cytology (FNAC), which confirmed the lesion's benign cystic nature. The imaging and clinical findings effectively ruled out alternative diagnoses such as branchial cleft cysts due to the lesion's multiloculated nature and anatomical spread. Management and Outcome: Initial management included close airway surveillance due to the lesion’s proximity to the pharyngeal space. Long-term care planning emphasized surgical or sclerotherapy options for the lymphangioma, along with ongoing neurologic monitoring and developmental interventions for PVL. A multidisciplinary team approach involving ENT, neurology, radiology, and pediatric surgery was employed. Conclusion: This case highlights the importance of MRI in diagnosing complex congenital cervical masses and associated neurological conditions. It underscores the need for a coordinated, multidisciplinary management strategy to address both the structural and neurodevelopmental needs of pediatric patients with dual pathologies.