An infant is brought to the clinic by the parents with the history of a swelling in the neck since birth. On examination, the swelling is found to be soft, partially compressible and brilliantly trans-illuminant. The most likely diagnosis is
cystic hygroma
The correct answer is cystic hygroma, a macrocystic lymphatic malformation caused by failure of the jugular lymph sacs to connect with the venous system. About 65-75 percent arise in the posterior triangle of the neck and roughly half to two-thirds are evident at birth. Because the loculi contain clear lymph, the swelling is soft, fluctuant, partially compressible and brilliantly trans-illuminant, the key bedside sign. It may swell on crying and large lesions threaten the airway; associations include Turner and Noonan syndromes. Treatment is sclerotherapy with OK-432 (picibanil) or bleomycin, or excision.
A sternomastoid tumour is a firm, fusiform, non-transilluminant swelling in the sternocleidomastoid appearing at 2-3 weeks with torticollis. A branchial cyst lies at the anterior border of the upper sternocleidomastoid, contains turbid cholesterol-rich fluid so does not transilluminate, and presents in young adults. A thyroglossal cyst is midline and moves on deglutition and tongue protrusion.
Key point: A brilliantly trans-illuminant, compressible posterior triangle swelling present since birth is a cystic hygroma until proved otherwise.
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1. It represents benign pathology of nipple areola complex
2. It is eczema like condition of nipple and areola
3. Erosion of nipple is seen
4. Nipple biopsy is required for definitive diagnosis
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