A Case of Vascular Malformation Identified in Pediatric Trauma

Cystic lymphangioma, a vascular anomaly considered to be a lymph sac derived from the fetal jugular vein remaining as a mass, is frequently noted in the lateral natal neck. It is classified as a vascular malformation by the International Society for the Study of Vascular Anomalies (ISSVA). While most cases are asymptomatic, it may grow into an unwieldy mass. We report a case of cystic lymphangioma and abnormal subclavian vein distribution incidentally identified during trauma treatment. A 2-year-old boy, with left supraclavicular fossa swelling, had fallen from a 120 cm height in a park and struck his left shoulder, which was left untreated due to the absence of pain. His family noted a slowly growing left supraclavicular fossa mass the following day. When first seen, he had a 30×40 mm mass in the left supraclavicular fossa. Palpation indicated a smooth, slightly soft, undulating, surface a cystic lesion containing a septum. Computed tomography (CT), magnetic resonance imaging (MRI), ultra sonography (US) needle aspirate of the cyst was bloody and malformation of the left subclavian vein distributing in the left supraclavicular region was noted. The mass was excised due to its rapid growth, together with part of the platysma muscle to which the mass strongly adhered. The two blood vessels entering the mass, were ligated and excised en bloc with the mass, which was diagnosed pathologically as cystic lymphangioma. No recurrence has occurred in the 4 years since surgery.