Uncommon Presentation of a Macrocystic Lymphatic Malformation in a Seven-Year-Old Boy: A Case Report

Macrocystic lymphatic malformations (old terminology: cystic hygromas) are considered a relatively rare condition; they mostly appear in the first two years of life. Cervical neck masses are a common presenting complaint in children to pediatric outpatient departments, the most common causes being infectious/inflammatory conditions of cervical lymph nodes. In this report, we aim to bring light to the fact that rarer causes like secondarily infected or hemorrhagic lymphatic malformations may also present similarly. Here, we present the case of a seven-year-old boy who had been asymptomatic before, presenting with a 10-day history of sudden-onset neck swelling associated with an upper respiratory tract infection. Treating the upper respiratory tract infection with an oral antibiotic also helped the cystic mass involute, showing that a secondary infection was the precipitating factor in the sudden increase in size of the cyst. Management options for these lymphatic malformations are between sclerotherapy and surgical excision according to indications. In this case, the size has resolved considerably with antibiotics so that the child does not require an active intervention at present and is planned to be under close radiological follow-up.