Atypical Cystic Hygroma in the Upper Back - A Congenital Swelling at Rare Presentation

Dr. Magalakshmi Narayanasamy, Dr. M. D. Gowthaman, Dr. Selvakumar K., Dr. T. M. Selvam

Abstract: Background: Cystic hygroma is a congenital lymphatic malformation commonly occurs in the cervicofacial region, with rare occurrences in atypical sites such as the upper back. Early diagnosis and appropriate management are essential to prevent complications such as infection, hemorrhage, or recurrence. Case Presentation: We present a case of a 1-year-old male child with a progressively enlarging, painless swelling over the left upper back, noted since birth. Clinical examination revealed a soft, non-tender, fluctuant mass with brilliant transillumination. Ultrasonography identified a well-defined, multicystic lesion in the subcutaneous plane without any communication with the thoracic cavity. Intraoperatively, a single cystic swelling was found, and complete excision was performed. Histopathology confirmed the diagnosis of cystic hygroma, revealing multiple cystically dilated lymphatic spaces lined by endothelial cells with minimal lymphocytic infiltration. Conclusion: This case highlights the importance of recognizing atypical presentations of cystic hygroma to ensure timely diagnosis and optimal management. Complete surgical excision remains the preferred treatment to prevent recurrence. Raising awareness of such rare occurrences aids clinicians in better decision-making and management of congenital lymphatic malformations.

Keywords: Cystic hygroma, Cystic lymphangioma, congenital lymphatic malformation, upper back swelling, surgical excision