Intrauterine Bleomycin Administration for Fetal Lymphatic Malformation: A Novel Therapeutic Approach—Case Report and Literature Review

Perinatal lymphangiomas are rare benign congenital malformations of the lymphatic system, whose potential for rapid growth and local invasiveness may pose significant risks to fetal well-being. This report presents a case of a large fetal lymphangioma diagnosed prenatally during a second-trimester ultrasound examination. The lesion was initially asymptomatic but subsequently progressed, resulting in ascites and pericardial effusion. In light of progressive fetal deterioration, prenatal sclerotherapy was performed using ultrasound-guided transabdominal administration of bleomycin. Despite the technical success of this procedure, the neonate developed severe cardiorespiratory failure and died shortly after delivery. This case highlights both the potential benefits and limitations of prenatal intervention in severe lymphatic malformations. This study also includes a concise review of current perinatal and postnatal management strategies. Despite advances in prenatal imaging and therapy, further studies are needed to optimize treatment and improve neonatal outcomes.