Cystic hygroma is a growth on the neck or head and usually present from birth. It can consist of one or more cysts and often becomes prominent as the baby grows. Cystic hygroma occurs due to developmental anomalies of the lymphoid system during the fetal period. This may often be associated with chromosomal abnormalities and other congenital malformations.
Symptoms of cystic hygroma in each baby may vary based on the size and location of the cyst. Complications may range from failure to thrive to severe airway obstruction.
Read this post to know about the causes, symptoms, complications, treatment, and prognosis of cystic hygroma in babies.
Causes Of Cystic Hygroma
Abnormalities of lymph vessels and lymph sacs during fetal development may cause cystic hygroma. The cysts are formed by embryonic lymphatic tissue that carries fluid and white blood cells.
Some babies may have cystic hygroma without any known reasons. Cystic hygroma may be associated with various chromosomal abnormalities and other conditions that include the following (1).
- Turner syndrome is a genetic anomaly in females due to a complete or partial lack of the X chromosome.
- Noonan syndrome is a genetic condition with abnormalities of various parts of the body.
- Down syndrome or trisomy 21 is a chromosomal anomaly with mental and physical developmental issues.
- Maternal viral infections during pregnancy cause abnormalities of development.
- Maternal alcohol use may also affect the development of the fetus.
Some fetuses with normal chromosomes may have cystic hygroma on the 10th-week ultrasound, and it may disappear by the 20th week. In comparison, there is a high chance of cystic hygroma to persist if the baby has chromosomal abnormalities.
Symptoms Of Cystic Hygroma
The symptoms may vary based on the size of the cystic hygroma. Visible neck growth is the common symptom of cystic hygroma in babies. Some babies may not have any symptoms other than a visible lump, while a few may have respiratory and feeding problems due to obstruction. Teeth malformations may also occur in older babies.
The cyst is usually a translucent, fluid-filled, and painless soft lump. It is usually common on the neck but may occur anywhere on the body. It may be visible at birth in some babies as a soft bulge under the skin (2).
Cystic hygroma may go unnoticed in a few babies and is often visible after they grow older or after a bout of upper respiratory tract infection, such as the common cold. It is recommended to seek medical attention if you notice growth or bulges on your baby’s neck.
Diagnosis Of Cystic Hygroma
The following tests are often done to examine cystic hygroma in babies after birth.
- Chest X-ray
- CT scan
- MRI scan
If the condition is noted on a pregnancy ultrasound, gynecologists may order amniocentesis and genetic testing since cystic hygroma may be associated with certain genetic disorders and birth defects. Maternal and fetal blood may also have increased levels of alpha-fetoprotein (AFP) in most cases.
Treatment For Cystic Hygroma
Surgical removal of the cystic hygroma is often performed since the success of other treatment options is limited. However, other treatments are usually given when the complete removal of cystic hygroma is impossible. These treatment modalities may include the following (4).
- Radiation therapy may help to prevent the growth of the cyst. However, the recurrence rate within a year is high among babies who underwent radiotherapy.
- Chemotherapy with drugs such as Bleomycin may cause fibrosis of the cyst due to inflammation and prevent its growth.
- Steroids may help to shrink large growths.
- Sclerotherapy uses an injection of sclerosing medications to shrink the lymph This procedure is considered safe, although there is some risk of bleeding and infection in the injection site.
Possible Complication Of Cystic Hygroma
The following complications are often seen in some babies with cystic hygroma (5).
- Recurrence after removal
- Damage of neck structures during surgery
- Obstructive sleep apnea
- Feeding and respiratory difficulties
Babies with larger cystic hygroma during the fetal period may require cesarean delivery since it is impossible for them to pass through the birth canal.
Prognosis Of Cystic Hygroma
Small cystic hygroma is more likely to resolve itself without causing any complications (5). However, cystic hygroma can often grow bigger than the size of the head in some babies. Extensive growth may affect the normal functioning of neck structures and neck movement.
The prognosis is good if the entire hygroma can be removed surgically. If the abnormal tissue is not obliterated, it may grow again and form hygroma. The long-term outcome may also depend on chromosomal anomalies, birth defects, and other coexisting factors.
Prevention of cystic hygroma may not be possible since it is mostly diagnosed on the first fetal ultrasound. Cystic hygroma is a manageable condition with proper treatment on time. You may discuss with the pediatrician to know the suitable treatment for your baby based on the size and location of the growth.