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Thoraco-Lumbar hemangiolymphangioma diagnosed antenatally by ultrasonography

Mutya S.A. Salvacion, MD, DPOGS and Cleofe B. Medina, MD, FPOGS, FPSUOG
Department of Obstetrics and Gynecology, Makati Medical Center

This is a case of a fetus with a complex cystic structure on the mid-thorax to the lumbar area detected by ultrasonography at 23 weeks age of gestation. There were no other structural abnormalities noted. The fetal Doppler of the middle cerebral and umbilical arteries were normal. The increase in size of the cystic mass, diagnosed as lymphangioma, and the appearance of pleural effusion at 27 weeks age of gestation prompted further surveillance with magnetic resonance imaging. It showed an extensive subcutaneous mass involving the right thoraco- lumbar region, to consider hemangioma. Expectant management, bringing the pregnancy close to term as possible, was planned. However, the progression of the effusion to the bilateral hemithorax and presence of fetal ascites led to the cesarean delivery of a live preterm male with a birthweight of 1,885 grams (4 lbs 1 oz), maturity index of 29 weeks and an Apgar score of 4, 7, 8 at the first, fifth and tenth minute of life. There was a 15 x 13 cm hemangiolymphangioma on the right thoraco-lumbar area. An ultrasound-guided thoracentesis was done to help alleviate fetal distress. The infant was observed in the neonatal intensive care unit and was sent home stable. Presently, the hemangiolymphangioma is gradually resolving.