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Weekly Chest CasesImaging Conference Cases

Case No : 8

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  • Age/Sex 17 / F
  • Case Title No specific symptom
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Courtesy
Inha University Hospital, Korea
Imaging Findings
Wedge shape, homogeneous water density in left thorax (lung parenchymal origin vs pleural origin)
Peripheral lining with irregular enhancing lesion (tortuous vascular structures)
Deviated lingular segmental pulmonary vessel (parenchymal origin?)
Differential Diagnosis
Intrapulmonary cystic mass

Congenital Cystic Adenomatoid Malformation, Type I
Pulmonary sequestration
Intrapulmonary bronchogenic cyst
Cystic lymphangioma
Loculated left pleural effusion with peripheral vascularity

Pleural epithelioid hemangioendothelioma
Tuberculous pleural effusion
Reviewy
Intrathoracic lymphangiomas: occasionally arising within the mediastinum (most commonly in the superior or anterior mediastinum)
Pulmonary lymphangioma: extremely rare
To date, in the English literature, nine cases have been documented as pulmonary lymphangioma. (1974.Wada et al.~2006.Nagayasu et al.)
Origin of lymphangiomas is controversial: developmental, hamartomatous, or neoplastic
Developmental anomalies rather than true neoplasms
Pulmonary lymphangiomas; asymptomatic masses, typically found in adults
In other cases, easy fatigability with sensation of chest heaviness and hemoptysis
Lymphangiomas are classified into three groups, depending on the size of the lymphatic channels 1) capillary lymphangiomas 2) cavernous lymphangiomas 3) cystic lymphangiomas

On CT

Cystic or multilobulated mass with homogeneous water density(CT demonstration of delicate septa is rare)
Well defined border
Inhomogeneous because of the presence of protein, fluid, blood, or fat in the lesion
Enhancement is not apparent after intravenous infusion of contrast medium
Histologically

Lymphangiomas are thin-walled, cystic, multilocular tumors, lined by endothelial cells and containing clear yellow fluid.
Their wall consists of connective tissue, smooth muscle, fat, blood vessels, nerve, or lymphatic tissue.
Immunohistochemical data

(+);factor VIII related protein
Benign lesion, easily treated by surgical excision

Keywords
Lung, Pleura, Congenital, Solitary Pulmonary Lymphangioma, Cystic and Cavernous Type with Anomalous Arteris
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Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

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