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Pediatric Radiology

, Volume 42, Issue 9, pp 1080–1088 | Cite as

Doxycycline sclerotherapy in children with lymphatic malformations: outcomes, complications and clinical efficacy

  • Arvind Shergill
  • Philip John
  • Joao G. AmaralEmail author
Original Article

Abstract

Background

Lymphatic malformations (LMs) are congenital lesions of the lymphatic system and consist of lymphatic channels and cystic spaces of varying sizes. Recent evidence has shown that LMs respond well to intralesional sclerotherapy.

Objective

The purpose of this retrospective study is to evaluate the outcome and efficacy of using doxycycline in treating macrocystic, microcystic and combined macro- and microcystic LMs in a tertiary-care pediatric center.

Materials and methods

Fifty children (32 boys, 18 girls) underwent doxycycline sclerotherapy for treatment of LMs between January 2005 and October 2010. Demographics, imaging, doxycycline treatment details, complications and follow-up details were documented.

Results

The mean age at first treatment was 5.9 years (3 days–17.8 years), median 4.2 years. Cervicofacial (19/50 children) and truncal (16/50 children) locations were the most frequently affected. One hundred forty-six sclerotherapy sessions were performed in 50 children (mean 2.9/child). The mean doxycycline dose/kg body weight for 146 sessions was 15.3 mg/kg (0.6–85.7 mg/kg). Complications occurred in 4/146 procedures. Clinical follow-up showed excellent response in 14/16 children with macrocystic LMs, 21/27 children with combined LMs and 4/7 children with microcystic LMs.

Conclusion

Doxycycline is a safe and effective sclerosant agent for treating LMs in children, with a low complication rate.

Keywords

Doxycycline sclerotherapy Lymphatic malformations Efficacy Safety Complications Outcomes Children 

References

  1. 1.
    Okazaki T, Iwatani S, Yanai T et al (2007) Treatment of lymphangioma in children: our experience of 128 cases. J Pediatr Surg 42:386–389PubMedCrossRefGoogle Scholar
  2. 2.
    Shiels WE, Kenney BD, Caniano DA et al (2008) Definitive percutaneous treatment of lymphatic malformations of the trunk and extremities. J Pediatr Surg 43:136–139PubMedCrossRefGoogle Scholar
  3. 3.
    Legiehn GM, Heran MK (2006) Classification, diagnosis, and interventional radiologic management of vascular malformations. Orthop Clin N Am 37:435–474CrossRefGoogle Scholar
  4. 4.
    Giguère CM, Bauman NM, Smith RJ (2002) New treatment options for lymphangioma in infants and children. Ann Otol Rhinol Laryngol 111:1066–1075PubMedGoogle Scholar
  5. 5.
    Alqahtani A, Nguyen LT, Flageole H et al (1999) 25 years’ experience with lymphangiomas in children. J Pediatr Surg 34:1164–1168PubMedCrossRefGoogle Scholar
  6. 6.
    Nehra D, Jacobson L, Barnes P et al (2008) Doxycycline sclerotherapy as primary treatment of head and neck lymphatic malformations in children. J Pediatr Surg 43:451–460PubMedCrossRefGoogle Scholar
  7. 7.
    Burrows PE, Mitri RK, Alomari A et al (2008) Percutaneous sclerotherapy of lymphatic malformations with doxycycline. Lymphat Res Biol 6:209–216PubMedCrossRefGoogle Scholar
  8. 8.
    Cordes BM, Seidel F, Sulek M et al (2007) Doxycycline sclerotherapy as the primary treatment for head and neck lymphatic malformations. Otolaryngol Head Neck Surg 137:962–964PubMedCrossRefGoogle Scholar
  9. 9.
    Dubois J, Garel L, Abela A et al (1997) Lymphangiomas in children: percutaneous sclerotherapy with an alcoholic solution of zein. Radiology 204:651–654PubMedGoogle Scholar
  10. 10.
    Lee BB, Kim YW, Seo JM et al (2005) Current concepts in lymphatic malformation. Vasc Endovasc Surg 39:67–81CrossRefGoogle Scholar
  11. 11.
    Ogita S, Tsuto T, Nakamura K et al (1994) OK-432 therapy in 64 patients with lymphangioma. J Pediatr Surg 29:784–785PubMedCrossRefGoogle Scholar
  12. 12.
    Kim KH, Sung M, Roh J et al (2004) Sclerotherapy for congenital lesions in the head and neck. Otolaryngol Head Neck Surg 131:307–316PubMedCrossRefGoogle Scholar
  13. 13.
    Niramis R, Watanatittan S, Rattanasuwan T (2010) Treatment of cystic hygroma by intralesional bleomycin injection: experience in 70 patients. Eur J Pediatr Surg 20:178–182PubMedCrossRefGoogle Scholar
  14. 14.
    Shiels WE, Kang R, Murakami JW et al (2009) Percutaneous treatment of lymphatic malformations. Otolaryngol Head Neck Surg 141:219–224PubMedCrossRefGoogle Scholar
  15. 15.
    Caliendo MV, Lee DE, Queiroz R et al (2001) Sclerotherapy with use of doxycycline after percutaneous drainage of postoperative lymphoceles. J Vasc Interv Radiol 12:73–77PubMedCrossRefGoogle Scholar
  16. 16.
    Folk JJ, Musa AG (1995) Management of persistent lymphocele by sclerotherapy with doxycycline. Eur J Obstet Gynecol Reprod Biol 60:191–193PubMedCrossRefGoogle Scholar
  17. 17.
    Robinson LA, Fleming WH, Galbraith TA (1993) Intrapleural doxycycline control of malignant pleural effusions. Ann Thorac Surg 55:1115–1121PubMedCrossRefGoogle Scholar
  18. 18.
    Suskind DL, Tavill MA, Handler SD (2000) Doxycycline sclerotherapy of benign lymphoepithelial cysts of the parotid: a minimally invasive treatment. Int J Pediatr Otorhinolaryngol 52:157–161PubMedCrossRefGoogle Scholar
  19. 19.
    Tang S, Sreenarasimhaiah J, Tang L et al (2007) Endoscopic injection sclerotherapy with doxycycline for mediastinal and esophageal lymphangiohemangioma. Gastrointest Endosc 66:1196–1200PubMedCrossRefGoogle Scholar
  20. 20.
    Lass A, Brinsden P (1999) The role of ovarian volume in reproductive medicine. Hum Reprod Update 5:256–266PubMedCrossRefGoogle Scholar
  21. 21.
    Sacks D, McClenny TE, Cardella JF et al (2003) Society of interventional radiology clinical practice guidelines. J Vasc Interv Radiol 14:S199–S202PubMedCrossRefGoogle Scholar
  22. 22.
    Emran MA, Dubois J, Laberge L et al (2006) Alcoholic solution of zein (Ethibloc) sclerotherapy for treatment of lymphangiomas in children. J Pediatr Surg 41:975–979PubMedCrossRefGoogle Scholar
  23. 23.
    Molitch HI, Unger EC, Witte CL et al (1995) Percutaneous sclerotherapy of lymphangiomas. Radiology 194:343–347PubMedGoogle Scholar
  24. 24.
    Alomari AI, Karian VE, Lord DJ et al (2006) Percutaneous sclerotherapy for lymphatic malformations: a retrospective analysis of patient-evaluated improvement. J Vasc Interv Radiol 17:1639–1648PubMedCrossRefGoogle Scholar
  25. 25.
    Hurewitz AN, Lidonicci K, Wu CL et al (1994) Histologic changes of doxycycline pleurodesis in rabbits. Effect of concentration and pH. Chest 106:1241–1245PubMedCrossRefGoogle Scholar
  26. 26.
    Kirse DJ, Suen JY, Stern SJ et al (1996) Histologic effect of doxycycline sclerotherapy on rat femoral nerve. Head Neck 18:506–511PubMedCrossRefGoogle Scholar
  27. 27.
    Hoff DS, Gremmels DB, Hall KM et al (2007) Dosage and effectiveness of intrapleural doxycycline for pediatric postcardiotomy pleural effusions. Pharmacotherapy 27:995–1000PubMedCrossRefGoogle Scholar
  28. 28.
    Volovitz B, Shkap R, Amir J et al (2007) Absence of tooth staining with doxycycline treatment in young children. Clin Pediatr (Phila) 46:121–126CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Department of Diagnostic Imaging, Division of Image Guided TherapyThe Hospital for Sick Children, University of TorontoTorontoCanada

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