Treatment of mediastinal lymphatic malformation in children: an analysis of a nationwide survey in Japan

Pediatric mediastinal masses

Mediastinal masses are categorized based on the International Thymic Malignancy Interest Group (ITMIG) classification into prevascular, visceral and paravertebral compartments. The schema is based on cross-sectional imaging, mainly CT, and helps with generating a differential diagnosis based on location of the mass. Up to half of all pediatric mediastinal tumors are malignant. In this review we describe mediastinal masses that are relevant to the pediatric population, as well as the role of MR imaging of mediastinal masses and its advantages.

Long-term results of sclerotherapy for cervical-thoracic-mediastinal lymphatic and venous malformations: A case report

Cervical-thoracic-mediastinal LVMs in infants is rare, and very difficult to be cured because of life-threatening risk and recurrence. An infant with cervical-thoracic-mediastinal LVMs was treated in our department. Left neck was thick at birth, usually depressed, lazy and inactive. He showed dyspnea after about 3 min of automatic activity, with increased wheezing and open-mouth breathing, squatting after walking no more than 6 steps. There were masses and bulges in the left submandibular area and the left neck. The left cervical root and left clavicle were full. LVMs was diagnosed, and treated by sclerotherapy with bleomycin and triamcinolone acetonidein in a phased and step-by-step manner. The thoracic LVMs and mediastinal LVMs were cannulated under general anesthesia B-ultrasound guidance with an indwelling catheter; drugs were administered via the catheter. After several sessions, the submandibular LVMs and cervical LVMs were completely regressed, the thoracic LVMs and mediastinal LVMs were approximately 95 % regressed. Follow-up of 11 years, there was no recurrence; the lungs, thoraxes, and spines were well developed and free to move. Surgical resection of thoracic-mediastinal LVMs has high life-threatening risk, especially in children, and can't remove all of the LVMs. Comparing with surgical resection, sclerotherapy has the advantages of minimally invasive, low risk, conveniently repeated treatment, obvious curative effect. Therefore, cervical-thoracic-mediastinal LVM in infants can be effectively cured by sclerotherapy; the sclerotherapy has no obvious side effect on the development.

Complex lymphatic malformations in pediatrics: a review of treatment options

INTRODUCTION

Lymphatic malformations (LMs) are low-flow lesions resulting from abnormalities in the development of lymphatics. The management of these lesions is complex and involve the collaboration of many specialties. The purpose of this review is to summarize current knowledge regarding the different therapeutic options used in complex lymphatic malformations, analyzing their indications, efficacy and complications.

EVIDENCE ACQUISITION

A search was made using the algorithm: "(lymphatic abnormality OR lymphatic malformation OR lymphangioma OR cystic hygroma) AND (extensive OR giant OR complex) AND (therapeutics OR treatment) AND (child OR children)". Of the 120 articles found, 53 were included.

EVIDENCE SYNTHESIS

Historically, surgery was the treatment of choice for this type of lesions. However, excision was often incomplete, associated with high rates of recurrence and severe complications. The use of sclerotherapy emerged as a minimal invasive option appropriate in selected cases as a single or adjuvant therapy. Inhibitors of the mammalian target of rapamycin, such as sirolimus, now play a central role in the treatment of complex malformations resistant to sclerotherapy, recurrent after surgery or more extensive malformations that affect vital structures. Other therapeutic options as sildenafil and laser ablation are also recognized as effective in selected cases.

CONCLUSIONS

Looking through the literature over the last decade authors realize that surgery had gradually been replaced by less invasive options such as sirolimus with or without adjuvant sclerotherapy. In conclusion, each treatment option seems to have its own indications and characteristics, which must be considered in therapeutic decision and individualized for each patient.

Mediastinal Masses in Children: Radiologic-Pathologic Correlation

Most pediatric masses in the chest are located in the mediastinum. These masses are often initially detected incidentally on chest radiographs in asymptomatic children, although some patients may present with respiratory symptoms. At chest radiography, the mediastinum has been anatomically divided into anterior, middle, and posterior compartments. However, with the International Thymic Malignancy Interest Group classification scheme, which is based on cross-sectional imaging findings, the mediastinum is divided into prevascular, visceral, and paravertebral compartments. In the prevascular compartment, tumors of thymic origin, lymphomas, germ cell tumors, and vascular tumors are encountered. In the visceral compartment, lymphadenopathy and masses related to the foregut are seen. In the paravertebral compartment, neurogenic tumors are most common. Using the anatomic location in combination with knowledge of the imaging and pathologic features of pediatric mediastinal masses aids in accurate diagnosis of these masses to guide treatment and management decisions. An invited commentary by Lee and Winant is available online. ^©RSNA, 2021.

Indications for tracheostomy in children with head and neck lymphatic malformation: analysis of a nationwide survey in Japan

PURPOSE

Airway obstruction caused by lymphatic malformation (LM) in the head and neck may require a tracheostomy. We present the results of our analysis of a nationwide survey on the indications for tracheostomy in children with head and neck LM.

METHODS

We analyzed data in relation to tracheostomy based on a questionnaire about 518 children with head and neck LM without mediastinal involvement.

RESULTS

Tracheostomy was performed for 43 of the 518 children. Most (32/43) of these children were younger than 1 year of age and the tracheostomy was almost always performed for airway obstruction (40/43). The lesion was in contact with the airway in 32 (72%) of these children, but in only 58 (12%) of the 473 children who were managed without tracheostomy. When the maximum circumferential area of contact was compared, only 20 (27%) of 74 patients with maximum contact of less than a half-circle required tracheostomy, whereas 11 of 13 with maximum contact of more than a half-circle required tracheostomy (P = 0.0001). Six patients without airway contact required tracheostomy because of acute swelling caused by hemorrhage, infection, or both.

CONCLUSIONS

Children with head and neck LM required tracheostomy to relieve airway obstruction. Tracheostomy should be considered if the lesion is in contact with the airway and surrounds more than a half-circle, and when it causes acute swelling.