Unusual Presentation of a Large Multi-Septated Cystic Hygroma: A Case Report and Comprehensive Literature Review

Background: Cystic hygromas are primarily found in the cervicofacial, thoracic, and abdominal regions, with limited occurrences in other areas. Despite existing literature on this condition, comprehensive descriptions and MRI findings of cystic hygromas in the extremities are rare. Aim: This case report aims to present a unique instance of a cystic hygroma in the left thigh. The objective is to provide detailed insights into the characteristics of this atypical presentation. Case Presentation: The case involves a 2-year-10 month-old girl with a cystic hygroma in her left thigh. The report includes a comprehensive description of the lesion’s clinical features and diagnostic evaluation, emphasizing the MRI findings to enhance understanding of this rare occurrence. Conclusion: This case report highlights the rarity of cystic hygromas outside the cervicofacial, thoracic, and abdominal regions, explicitly focusing on the occurrence in the left thigh. By presenting detailed insights into the clinical features, MRI findings, histopathological findings, and the surgical approach employed, this report contributes to the existing knowledge on this condition in atypical locations and informs future treatment strategies.

Rare combination of traumatic subarachnoid-pleural fistula and intracranial subdural hygromas:A case report

BACKGROUND Subarachnoid-pleural fistula(SPF)is a complex and rare condition characterized by a pathological shunt between the subarachnoid and pleural spaces.It can lead to the accumulation of cerebrospinal fluid(CSF)in the pleural space,pneumocephalus,and the development of central nervous system infection.Trauma or thoracic spinal surgery are common causes of SPF,with symptoms including postural headache,consciousness status changes,and dyspnea.The combination of SPF and subdural hygroma is a severe and rare condition,with little existing literature on its clinical correlation.CASE SUMMARY We report a case of an 83-year-old male patient with traumatic SPF and bilateral frontal subdural hygroma following a fall from height.The patient initially presented with severe lower back and buttock pain.During admission,the patient developed worsening lower limb weakness and pleural effusion.Further investigation revealed the presence of subdural hygromas with mass effect,requiring emergency bilateral subdural drainage.A multidisciplinary approach was undertaken to manage this complex condition,including intervention for hypovolemic CSF status and subdural hygroma management.The pleural effusion eventually resolved and the patient attained a higher level of con-sciousness after bilateral hygroma drainage surgery.We also reviewed the present literature relating to this rare combination of medical conditions.CONCLUSION Traumatic SPF with subsequent subdural hygroma is a rare but serious combination.Although the optimal treatment strategy for this complex condition remains uncertain,our literature review suggested that a multidisciplinary approach,including intervention for hypovolemic CSF and management of the subdural hygroma,is the most beneficial.

Drainage and Cranioplasty as a Treatment for Traumatic Subdural Hygroma Secondary to Decompressive Craniectomy

Background: Decompressive craniectomy (DC) is performed to accommodate life-threatening brain swelling when medical treatment fails. This procedure carries the risk of developing traumatic subdural hygroma (TSH) that can adversely affect the neurological status of the patient. The treatment for persistence of TSH includes drainage and shunt placement or drainage and membranectomy. In this paper, we present treatment of two patients whose TSH was effectively treated with simple drainage and cranioplasty. Case Presentation: Patient 1: The patient is a 34-year-old female who had bilateral craniectomy for brain swelling. Four weeks later she became less interactive. CT scan showed bilateral subdural hygroma with 2 cm midline shift to the left. Her clinical status improved and CT scans showed resolution of the hygroma after simple evacuation of the hygroma and cranioplasty. Patient 2: The patient is a 57-year-old male who had post-traumatic acute subdural hematoma and brain swelling on the left side. The clot was evacuated and the bone flap was left out. After showing initial improvement, 10 weeks after the initial surgery the patient progressively worsened and became unresponsive. CT scans showed a large subdural hygroma on the right with midline shift to the left. Simple evacuation of the hygroma and cranioplasty was done. This resulted in radiological and clinical improvement of the patient. Conclusions: Both patients underwent simple drainage and cranioplasty, which resulted in clinical and radiological improvement. This finding suggests that other procedures such as membranectomy and shunting may not be necessary to treat TSH.

Subdural Hygroma: Different Treatment Modalities and Clinical Outcome

Background: Subdural hygroma (SDHy) is a collection of cerebrospinal fluid (CSF) under the dural membrane. It is usually asymptomatic but may alter consciousness. Management is still a matter of controversy (conservative Vssurgical) especially when consciousness is a concern. Aim: To assess the different treatment modalities of SDHy regarding the patients’ characteristics and clinical outcome, finding out the significant differences and the future recommendations. Patients and Methods: In this prospective one-year clinical case study, thirty patients were included. Patients’ sociodemographic and clinical characteristics were analyzed. Fifteen patients were managed conservatively whereas the rest were managed surgically. Outcome was correlated with the patients’ characteristics. Results: Twenty four men (80%) and 6 women (20%). Mean age = 25.2 years old. Hygroma was unilateral in 63.3% and fronto-parietal in 60% of patients. The most frequent concomitant injuries were brain contusions (50%) and subarachnoid hemorrhage (33.3%), respectively. The conservative group was treated symptomatically. The surgical group had burr hole evacuation (12 patients) and subdural peritoneal shunt (3 patients). No statistical significance in outcome in either group, but surgical group showed better outcome (73.3%) than conservative group (53.3%). Younger patients have good outcome (65%) compared to (55.3%) in old patients. Patients with severe GCS showed poor outcome (8/8 patients, 100%), whereas mild and moderate GCS patients showed good outcome (19/22 patients, 86%). Conclusion: SDHy though is a benign lesion its management is a matter of controversy. The decision of surgery is affected by GCS and neurological deterioration. Generally, the surgical option is more favorable but the conservative option should be the role as far as there is no concern on consciousness.

Cystic Hygroma of the Neck: Ultrasound Findings

This is a report of a case of cystic hygroma of the neck in a female child. Cystic hygroma is a rare congenital malformation of the lymphatic system, most frequently detected in the head and neck region. Ultrasound is considered as being the first level study to investigate a suspected mass suggestive of cystic hygroma. The Authors describe the main diagnostic ultrasound features for this type of lymphatic lesion.

Notch3/DLL4信号通路对颈部淋巴水囊瘤后淋巴管发育的影响

目的:探究Notch3/DLL4信号通路对颈部淋巴水囊瘤(CH)后淋巴管成熟发育的影响。方法:选取C57BL/6小鼠和C57BL/6背景Notch3基因敲入小鼠,将两种小鼠分为正常组(对照组)和Notch3基因敲入组(突变组)。选取F2代小鼠处死,取小鼠颈部淋巴结分别进行HE染色、Masson染色、RT-qPCR、Western blot、免疫组化检测。结果:HE及Masson染色结果显示,与对照组比,突变组小鼠的淋巴结构被显著破坏,细胞纤维化严重。RT-qPCR结果显示,与对照组比,突变组小鼠淋巴结中DLL4、Hes1和VEGFR3 mRNA表达显著下降(P<0.05)。Western blot结果显示,与对照组比,突变组小鼠淋巴结中DLL4、Hes1和VEGFR3蛋白表达显著下降(P<0.05)。免疫组化结果显示,与对照组相比,突变组小鼠淋巴结中DLL4、Hes1、Ang2、VEGFA和VEGFR3染色较浅,蛋白表达水平下降(P<0.05)。结论:Notch3/DLL4信号通路能够调控小鼠颈部CH的形成,其机制可能与淋巴管发育有关。

Compressive brainstem deformation resulting from subdural hygroma after neurosurgery： a case report

Acute and chronic subdural hygromas are common postoperative clinical complications of ventricularshunting, arachnoid cyst marsupialization and arachnoid cyst resection.^1 This article introduces a case of subdural hygroma after resection of a space-occupying lesion in the left lateral ventricle that resulted in compressive brainstem deformation and reviewed the recent related literature. The conclusion is that in related surgical procedures, prevention of rapid cerebrospinal fluid loss and excessive fluctuations in intracranial pressure are especially important.

硬膜下积液演变为慢性硬膜下血肿相关危险因素研究

目的探讨硬膜下积液演变为慢性硬膜下血肿(chronic subdural hematoma,CSDH)的相关危险因素。方法回顾性分析2016年1月至2021年12月于金华市中心医院就诊的99例硬膜下积液患者的临床资料,根据是否演变为CSDH将其分为血肿组和非血肿组,采用多因素Logistic回归分析探讨硬膜下积液演变为CSDH的影响因素。结果99例硬膜下积液患者23例演变为CSDH,发生率23.2%。血肿组患者伴脑损伤、积液厚度≥1cm、双侧积液占比均显著高于非血肿组(P<0.05),阿托伐他汀使用率显著低于非血肿组(P<0.05)。多因素Logistic回归分析显示,伴脑损伤、积液厚度≥1cm、双侧积液均是硬膜下积液演变为CSDH的独立危险因素,阿托伐他汀治疗是保护性因素(P<0.05)。结论硬膜下积液易演变为CSDH,临床工作中对伴脑损伤、积液厚度≥1cm、双侧积液的硬膜下积液患者应密切随访观察,建议口服阿托伐他汀以降低CSDH的发生率。

超声检测颈部透明层增厚及胎儿淋巴水囊瘤与染色体异常的相关性及妊娠结局分析

目的:探索超声检测颈部透明层(NT)增厚、胎儿淋巴水囊瘤(CCH)与染色体异常以及妊娠结局的相关性。方法:选取医院收治的64例CCH孕妇,均进行超声检查,根据超声结果选择性进行产前介入治疗,分别行全基因组染色体微阵列分析(CMA)或染色体核型检测,分析CCH孕妇的基因芯片、染色体检测结果及妊娠结局。结果:64例孕妇经产前超声检查,均确诊为CCH,测量胎儿NT厚度均≥2.5 mm,平均厚度为(5.43±1.19)mm。64例孕妇中33例胎儿NT值2.5~3.0 mm,19例胎儿NT值3.1~3.5 mm,12例胎儿NT值>3.5 mm,NT值>3.5 mm的不良妊娠结局高于NT值3.1~3.5 mm和2.5~3.0 mm,差异有统计学意义(x^(2)=3.651,x^(2)=2.459;P<0.05)。64例孕妇38例胎儿染色体异常(1例因骶尾段脊柱裂引产,37例终止妊娠);8例基因芯片异常(1例经阴道分娩,健康,1例自然流产,5例终止妊娠);18例胎儿经染色体、芯片检查均未发现异常(8例经超声检查未见异常者且均为活产,1例自然流产,1例死胎,6例选择终止妊娠,2例活产)。结论:尽早对CCH孕妇进行胎儿超声NT值检测,并对于异常者结合染色体、基因分析综合判断,可对妊娠结局起到预判。

胎儿淋巴水囊瘤与染色体异常的相关性研究及妊娠结局分析

目的:探讨胎儿颈部淋巴水囊瘤(CCH)与染色体异常的相关性,以及早孕期CCH胎儿的妊娠结局。方法:选取2012年1月1日至2016年6月1日在广州医科大学附属第三医院胎儿医学科门诊行早孕期NT筛查发现CCH的胎儿160例。孕妇均行产前诊断,对染色体及基因芯片结果未见异常的胎儿,建议孕妇于妊娠20～24周接受详细的胎儿III级排畸超声筛查。新生儿随访时间为出生后2～25个月。结果:160例行遗传学诊断的早孕期CCH样本中,染色体核型分析44例,行高分辨CMA分析116例。染色体异常82例,其中最常见的染色体异常为Turner's综合征(31例,33.7%),其次为18三体(24例,26.1%)、21三体(17例,18.5%),13三体7例,染色体平衡易位2例,染色体嵌合1例。基因芯片异常10例,其中6例致病性拷贝数异常。染色体及芯片未见异常的68例中,除10例死胎外,发现超声结构异常18例。染色体、芯片及超声均未见异常且选择继续妊娠的病例中,活产率为98%。截止随访日,活产胎儿暂未发现明显异常。胎儿心脏异常尤其是室间隔缺损在非染色体异常病例中的发生率较高。26例双胎中,约57.7%发现明显染色体异常,染色体检查、芯片及超声检查均未见异常的病例中,选择继续妊娠的4例双胎均活产健康。结论:对于早孕期CCH的预后,需排除常见的染色体异常及致病性拷贝数变异,同时还需结合胎儿排畸超声情况综合判断。如均未见明显异常,且后期未发生胎儿水肿的孤立性淋巴水囊瘤的胎儿出生后预后良好。

122例外伤性急性硬膜下积液的CT诊断

目的 :加深对外伤性急性硬膜下积液 (ATSH )的认识和提高其早期确诊率。方法 :回顾性分析 12 2例ATSH的CT表现、演变过程及其转归情况。CT扫描均用轴位平扫。结果 :本组ATSH 12 2例 186处 ,少量积液 89例 ;迟发性积液 145处 ;积液位于额颞部或 (和 )大脑镰旁前上部 114例 ;复合性积液 10 1例 (合并蛛网膜下腔出血 72例、脑挫裂伤 6 1例 ) ;10 3例经保守治疗痊愈 ,3例演变为慢性硬膜下血肿 ,5例经手术治愈 ;早期漏诊 2 5例。结论 :大脑镰旁前上部是ATSH的好发部位之一 ;少量的ATSH早期可漏诊 。

外伤性硬膜下积液演变为慢性硬膜下血肿临床特点分析

目的:探讨外伤性硬膜下积液演变为慢性硬膜下血肿的临床特点。方法:回顾性分析5例由外伤性硬膜下积液演变的慢性硬膜下血肿患者的临床表现及演变过程,并复习相关文献。结果:本组59例外伤性硬膜下积液患者有5例演变为慢性硬膜下血肿,转化率8.47%。该5例患者均有明确头部外伤史,血肿位于单侧额颞4例、单侧颞顶1例,血肿形成后临床表现多样。5例患者均接受钻颅血肿引流术治疗,术后痊愈。结论:外伤性硬膜下积液是慢性硬膜下血肿的来源之一,发病年龄有较宽的范围,常发生于颅脑损伤很轻微、积液部位在单侧额颞部、经保守治疗病例中。

86例胎儿淋巴水囊瘤超声表现及预后分析

目的：通过对比86例胎儿淋巴水囊瘤的超声表现及妊娠结局，进一步深入分析胎儿淋巴水囊瘤的产前诊断思路及预后判断。方法：对2002年1月～2005年12月在我院行产前超声检查发现的86例胎儿淋巴水囊瘤孕妇进行随访，记录产后新生儿复查情况或引产者的相关尸检结果。结果：86例孕妇中，淋巴水囊瘤自行消失的有6例，合并染色体异常的有9例，继续妊娠至产后新生儿行外科治疗的有12例。结论：胎儿淋巴水囊瘤在遗传性超声中具有重要意义，且不同类型的淋巴水囊瘤，超声表现不同，预后亦不同。

长时间应用甘露醇致硬膜下积液三例

目的对3例长时间应用甘露醇导致硬膜下积液的发生机制及治疗进行初步探讨。方法回顾性分析我院神经外科收治的因过度应用甘露醇出现硬膜下积液的3例颅脑损伤患者的临床资料,其中2例实行开颅手术,均应用甘露醇静点降颅压,半月后出现硬膜下积液。结果停用甘露醇后硬膜下积液不见好转,应用锥颅置管外引流术当时有效,拔除引流管后硬膜下积液又恢复原状,采用硬膜下积液腹腔分流术缓解。结论颅脑损伤后应用甘露醇时间太长易形成硬膜下积液,硬膜下积液腹腔分流术是治疗硬膜下积液的有效措施。

成人颈部囊性水瘤外科治疗(附9例报道)

目的回顾性分析9例成人颈部囊性水瘤患者的临床病例资料,总结对该病的外科治疗。方法收集2014年4月~2017年6月首都医科大学附属北京友谊医院耳鼻咽喉头颈外科诊治的9例成人颈部囊性水瘤患者的临床资料,其中男5例,女4例;年龄18-63岁。均为单侧发病,其中左侧4例,右侧5例。根据de Serres分期Ⅰ期5例,Ⅱ期及Ⅲ期各2例;水瘤位于咽旁间隙7例,颈后三角1例,舌骨前下方1例。结果所有患者均经颈外径路完整切除,随访5~38个月未见复发。2例出现Horner征,自行恢复,无其他严重并发症。结论对于成人颈部囊性水瘤患者,手术应作为治疗的首选方式,完整剥离并切除囊壁是减少复发的关键。

儿童蛛网膜囊肿破裂致硬膜下积液1例病例报告及文献复习

目的:探讨儿童蛛网膜囊肿合并硬膜下积液的病因、临床特征及治疗方法。方法:报告1例儿童左颞蛛网膜囊肿破裂致硬膜下积液病例,结合文献探讨该疾病的病因、临床表现、影像学特征及治疗。结果:在蛛网膜囊肿破裂致硬膜下积液的病例中,80%病例的囊肿位于中颅窝,半数以上病例有明确外伤史,CT或MRI可明确诊断,治疗多采取引流或开窗手术。结论:蛛网膜囊肿和硬膜下积液相关联的病例少见。CT或MRI具有诊断价值,一般采取手术治疗,目前倾向引入显微手术及内窥镜技术来治疗,建议根据囊肿类型选取分流手术。

侧裂池蛛网膜造瘘、置管外引流治疗外伤性硬膜下积液

目的探讨外伤性硬膜下积液显微手术治疗方法及其疗效。方法 22例经保守治疗无效的外伤性硬膜下积液患者,行翼点小骨窗入路、侧裂池蛛网膜造瘘+置管外引流治疗,对手术技术进行阐述并对临床资料及手术结果进行回顾性分析。结果无手术相关的并发症发生。术后1个月时,21例患者积液消失或明显好转;1例患者积液仍较多,后行硬膜下腔-腹腔分流后治愈。术后3个月时,所有患者积液消失或基本消失。结论经翼点小骨窗入路、侧裂池蛛网膜造瘘+置管外引流是治疗外伤性硬膜下积液安全、有效的方法。

孕早期淋巴水囊瘤胎儿的绒毛染色体及微阵列结果分析

目的分析孕早期超声发现的单纯性淋巴水囊瘤胎儿的绒毛染色体及微阵列结果,为遗传咨询提供依据。方法纳入孕14周前超声诊断为单纯性淋巴水囊瘤并行绒毛穿刺产前诊断的单胎妊娠胎儿。回顾性分析其染色体及微阵列结果。结果 29例胎儿中,共有21例(72%)胎儿染色体异常,其中18例为染色体非整倍体异常,1例为环状染色体,1例为染色体易位,1例为染色体部分重复。微阵列结果中,共有22例(76%)异常。结论早孕期超声诊断为单纯性淋巴水囊瘤胎儿染色体异常率较高,array-CGH检查有助于明确染色体异常中的具体片段及可能包含的致病基因。染色体核型分析仍是单纯性淋巴水囊瘤胎儿查找病因的重要方式。

胎儿颈部淋巴水囊瘤与染色体核型异常的关联分析

目的通过对12L45例胎儿颈部淋巴水囊瘤的超声表现及染色体核型，进一步深入分析胎儿颈部淋巴水囊瘤的产前诊断思路及预后判断，以指导具体临床咨询和处理。方法对2006年8月～2011年7月在南京医科大学附属苏州医院行产前超声检查发现的128例胎儿颈部淋巴水囊瘤孕妇进行遗传咨询、产前诊断、随访，记录产后新生儿复查情况或引产者的相关尸检结果。结果进行胎儿染色体核型分析的45例中有23例染色体核型异常，20例为45，XO（Turner综合征），占86．95％，其中嵌合型2例，分别为45，X／46，X，-Y＋r（Y），45，X／46，XY（大Y）；另有3例异常染色体核型分别为47，xY＋18（18-三体综合征），47，xY＋2l（21-三体综合征），46，XX，7q＋。随访16例染色体核型正常及1例羊水培养失败的孕妇，9例颈部淋巴水囊瘤增大（包括1例羊水培养失败），1例胎儿发展成全身水肿，1例心脏超声检查提示胎儿心脏复杂畸形，均予引产。共有6例出生，其中3例B超随访发现颈部淋巴水囊瘤自行消失，随访至新生儿，一般隋况好。另3例产后新生儿行外科治疗后现体健。结论超声对于发现胎儿颈部淋巴水囊瘤具有重要意义，早期超声胎儿染色体筛查结合胎儿染色体核型分析对于胎儿颈部淋巴水囊瘤的临床处理具有较准确的指导意义。