Lymphatic Malformation Discovered Post-Tonsillectomy in a 5-Year-Old Female




Khurshid, Bilal
Marcincuk, Michelle


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Presenter: Bilal Khurshid

Authors: Bilal Khurshid OMS-II, Michelle Marcincuk, MD

Title: Lymphatic Malformation Discovered Post-Tonsillectomy in a 5-Year-Old Female

Background: Lymphatic malformations (LM) are benign tumors of the lymphatic vessels that are a result of congenital abnormalities in the lymphatic system. They are found most in children younger than the age of 2 and are frequently localized in the head and neck regions. Despite being benign, LM still have potential for invasion, so they should still be monitored after discovery.

Case Information: A 5-year-old female presented to her otolaryngologist with recurrent serous otitis of both ears and enlarged tonsils and adenoids. The physician then performed a bilateral myringotomy with tube placement, and a tonsillectomy/adenoidectomy. A few days after the tonsillectomy, she presented with significant swelling, fever, lymphadenitis, and a large, layered fluid collection localized over the right side of her face and neck. The swelling was drained by interventional radiology; and then, an MRI was performed, which showed large cystic structures around the right parotid gland, temporomandibular joint, and pharyngeal area that was consistent with a LM.

Conclusion: Lymphatic malformations are primarily diagnosed in children. In this case, both the location and the method of discovery of this structure were uncommon. This LM was found in the parapharyngeal space, right next to the tonsil. Typically, LMs are not found this high in the head and neck region. Furthermore, this LM was likely only found due to the preceding tonsillectomy/adenoidectomy, which may have introduced an infectious nidus to the structure causing it to become inflamed and causing systemic symptoms in the patient. This case illustrates that the parapharyngeal space should be considered for LM and an infectious nidus post-surgery may lead to systemic symptoms. The treatment involved incision and drainage, with subsequent follow up with hematology/oncology for further clinical management.