Lymphographic-Like Technique for the Treatment of Microcystic Lymphatic Malformation Components of &lt;3 mm

American Journal of Neuroradiology

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Fig 1.
Lateral (A) and anteroposterior (B) plain radiography during a sclerotherapy session in a patient with a diffuse maxillofacial microcystic lymphatic malformation. She had been previously treated by an operation. Before sclerotherapy, on the T1-weighted coronal (C) and axial (E) views, the lymphatic malformation extended into the maxillofacial soft tissues, with multiple small diffuse hypointense microcystic lesions measuring <3 mm. No macrocyst was identified. After 7 sclerotherapy sessions and a cumulative dose of 90 mg of bleomycin, T1-weighted coronal (D) and axial (F) views demonstrate dramatic reduction in the size of the lymphatic malformation. However, soft tissues of the face remain thickened due to fat transformation (hyperintense) of the cysts.

Objective and subjective clinical results

Patient No.	Sex	Age (yr)	Site	No. of Sessions	MRI Findings		Subjective Clinical Symptom Findings^{^c}
Patient No.	Sex	Age (yr)	Site	No. of Sessions	% Decrease^{^a}	% Fat Transformations^{^b}	Subjective Clinical Symptom Findings^{^c}
1	M	5	Orbital	1	+	+	1
2	F	12	Maxillofacial	4	+	+	1
3	F	22	Tongue	7	+++	+++	2
4	F	8	Maxillofacial	2	+	+	1
5	F	24	Maxillofacial	8	+	+	1
6	F	32	Orbital	6	++	++	1
7	F	6	Orbital	2	++	No	0
8	F	23	Maxillofacial	1	NA	NA	NA
9	F	47	Tongue	7	++	++	1
10	M	5	Orbital	3	+++	+++	2
11	F	23	Orbital	2	+++	+++	2
12	M	1	Maxillofacial	4	+	+	1
13	F	2	Tongue	3	+++	+++	2
14	M	4	Orbital	2	+++	+++	2
15	F	8	Orbital	6	++	++	1
16	M	20	Maxillofacial	2	+	+	1

Note:—NA indicates not available.
↵a % Decrease: + = 0–10, ++ = 10–30, +++ = >30.
↵b % Fat transformation on T1WI and T2WI MRI: + = 0–10, ++ = 10–30, +++ = >30.
↵c Clinical evaluation: 0 = no improvement or progression, 1 = clinical improvement, 2 = resolution of symptoms.