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Imaging features, complications and differential diagnoses of abdominal cystic lymphangiomas

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Abstract

Purpose

The aim of the study is to describe the imaging features, complications and differential diagnoses of abdominal cystic lymphangiomas (ACLs).

Results

ACLs are benign lymphatic malformations that mainly arise in the subperitoneal space and the retroperitoneum. The typical presentation of an ACL is a multilocular lesion with homogenous serous content, presenting a thin wall and septa, usually free from adjacent organ compression. Atypical findings, including fat or hemorrhagic content, septal calcifications and unilocular presentation, are not uncommon. Rarely, ACLs can be revealed by acute complications, such as infection, hemorrhage, intussusception, complications with a twisting mechanism (including torsion around its own pedicle) or spontaneous rupture, which can be diagnosed by imaging. Ultrasonography and CT are the most useful modalities in emergency situations. MRI performs best in the noninvasive characterization of cystic lesions. ACLs should be differentiated from normal anatomic structures (e.g., cisterna chyli) or pitfalls (e.g., ascites, extrapancreatic necrosis, lymphocele) that can simulate ACLs. Among other primary peritoneal cystic lesions, benign cystic mesothelioma can be difficult to differentiate from ACL. Some neoplastic peritoneal lesions may have cystic components or content that looks like fluid on imaging (such as mucinous or myxoid content) and be misdiagnosed as ACL. Nodular or thick enhancement of the wall or septa should then be considered worrisome features and should not suggest ACL. ACLs mostly require a simple follow-up. If treatment is necessary, percutaneous sclerotherapy is a safe and effective alternative to surgery.

Conclusion

Imaging, especially MRI, allows the noninvasive diagnosis of ACL and helps to exclude potential malignant differential diagnoses.

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Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

ACL:

Abdominal cystic lymphangioma

CT:

Computed tomography

MRI:

Magnetic resonance imaging

US:

Ultrasonography

WI:

Weighted images

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Digestive Diagnostic and Interventional Radiology, University Hospital Claude Huriez – Regional University Hospital Center, rue Michel Polonoski, 59037, Lille Cedex, France

    M. Raufaste Tistet, O. Ernst, M. Lanchou, M. Vermersch & P. Lebert

Authors
  1. M. Raufaste Tistet
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  2. O. Ernst
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  3. M. Lanchou
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  4. M. Vermersch
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  5. P. Lebert
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Contributions

RTM and LP analyzed and interpreted the patient data. All authors read and approved the final manuscript.

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Correspondence to M. Raufaste Tistet.

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Raufaste Tistet, M., Ernst, O., Lanchou, M. et al. Imaging features, complications and differential diagnoses of abdominal cystic lymphangiomas. Abdom Radiol 45, 3589–3607 (2020). https://doi.org/10.1007/s00261-020-02525-3

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