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J Thorac Cardiovasc Surg 2003;125:736-737
© 2003 The American Association for Thoracic Surgery

Brief Communications

Spontaneous right cervicothoracic lymphocoele

From the Department of Surgery, Resurrection-St Joseph Hospital, Chicago, Ill,^a and the Division of Thoracic Surgery, University of Massachusetts Medical School, Worcester, Mass.^b

Presented at the annual scientific meeting of the Southeastern Surgical Society, Nashville, Tenn, Feb 3, 2002.

Received for publication May 12, 2002. Accepted for publication June 13, 2002. Address for reprints: Francis J. Podbielski, MD, Division of Thoracic Surgery, 67 Belmont St, Worcester, MA 01605-2657 (E-mail: Podbielf@ummhc.org).

The first 20% of the full text of this article appears below.

Subcutaneous accumulation of lymphatic fluid usually results from disruption of lymph channels or outflow obstruction. The cause of chylothorax, a subset of this disorder, has been classified by DeMeester ¹ into congenital, traumatic, diagnostic procedures (iatrogenic), and neoplastic categories. The primary imaging modalities to assess lymphocoeles are computed tomography and magnetic resonance imaging. Lymphoscintigraphy and lymphangiography are used occasionally to delineate the course of lymph flow. Isosulphan blue injection is used to aid in the localization of disrupted lymphatic channels during operative repair.

Treatment of groin and abdominal lymphocoeles consists of observation only, aspiration (often repeated), instillation of sclerosing agents, irradiation, and surgical closure-excision. Most cases of mediastinal lymphocoele can be attributed to iatrogenic ² or accidental ³ trauma, although large cysts of the thoracic duct in the mediastinum have been reported without a clear cause. ⁴ Even less frequently, these cysts manifest themselves as a supraclavicular mass confined to or predominantly located in the neck. ^5,6 Cysts of the right lymphatic system are extremely rare. Only one case of a mediastinal lymphocoele has been reported that was thought to arise from the right lymphatic system. ⁷

Clinical summary

The patient is a 32-year-old otherwise healthy woman who noticed the abrupt onset of a large right cervical-supraclavicular fossa fullness. The only recent physical exertion she could recall was a vigorous . . . [Full Text of this Article]

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