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Abstract: In a 38-year-old male patient, a neck mass was found 1 year ago and the patient was not diagnosed clearly on examination. Recently, he came to the clinic because of a mildly enlarged neck mass. MRI of the neck was performed, and the results suggested lymphatic duct malformation. After communication with the patient and his family, we decided to adopt a surgical + medication approach, and chose to perform a neck mass resection under general anesthesia. After active and effective treatment, the patient’s neck mass disappeared after surgery, and all indicators improved, and he was discharged successfully.
Basic information】Male, 38 years old
Disease Type】Lymphatic Duct Malformation
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of consultation】March 2022
Treatment plan】Surgical treatment (neck mass excision under general anesthesia) + medication (cefoperazone sodium tazobactam sodium for injection)
Treatment period】3 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect】No mass on palpation in the neck, all indexes improved
I. Initial consultation
The patient reported that he found a soft mass in the right neck with no pressure pain and redness, no swallowing difficulty and no obstruction in eating. The patient felt that the mass had grown mildly over the past year, so he visited our hospital. During the initial examination, the patient was clear, had no appearance of illness, no yellowish sclera, no enlargement of superficial lymph nodes, no abnormalities in the thorax, and clear breath sounds in both lungs. Later, a specialist examination was performed, and a mass was found on the right side of the patient’s neck, with soft texture, clear boundaries, no pressure pain and good mobility. Later, during the conversation with the patient and his family, it was found that the patient had normal mental, appetite, sleep, normal urine and stool, and no significant change in weight since the disease, and no previous history of underlying diseases or allergies. Based on the above findings, the patient was initially considered to be a lymphatic duct malformation and was admitted to the hospital for further diagnosis and treatment.
II. Treatment history
After admission, the patient continued to improve blood routine, blood glucose, blood lipid, liver and kidney function, C-reactive protein and other tests, and the results showed no abnormalities. MRI of the neck showed that the patient had an abnormal signal shadow in the subcutaneous fatty space of the right neck, with slightly high signal in T1WI and high signal in T2WI. The patient was diagnosed as a lymphatic duct malformation by combining all the examination results.
After discussing with the patient and his family, we chose to perform neck mass resection under general anesthesia, and the patient met the surgical requirements, so the surgery was performed. The operation was completed smoothly and the complete mass was removed. After the operation, the patient’s vital signs were monitored and he was sent to the ward and given cefoperazone sodium tazobactam sodium for injection for anti-infection treatment.
III. Treatment results
The patient came to the hospital with a mildly enlarged mass in the right neck, which was found one year ago and did not receive medical treatment. After admission, after a series of clinical examinations, the patient was diagnosed with lymphatic duct malformation and had indications for surgery. One day after the operation, the patient’s wound was checked for bleeding and infection, and there were no symptoms of nausea, vomiting and fever. Three days after the operation, the patient’s wound healed well and no mass was palpable on the right side of the neck, and no significant abnormality was seen on the follow-up ultrasound. During the follow-up outpatient visit 1 month after the operation, the patient was observed to be in a good mental state and had no obvious discomfort symptoms, and no obvious abnormality was seen on the follow-up ultrasound.
IV. Notes
We are glad that after a series of treatments, the patient’s neck mass disappeared and there were no other adverse reactions or signs of recurrence after surgery. However, since the patient experienced surgery after all, the patient himself and his family still need to pay more attention after discharge from the hospital, mainly including the following points.
1. Patients are advised to pay close attention to their own status and come to the hospital promptly once they have symptoms of discomfort, and not to make their own diagnosis so as not to delay their condition. If there are no abnormalities should also be regularly reviewed to prevent recurrence of the disease.
2, the patient’s family should accompany the patient more often, actively ease the patient’s emotions, pay attention to the patient’s mental state, and avoid aggravating the psychological burden.
3, patients should pay attention to a light diet after discharge from the hospital, and eat appropriate postoperative food that is easy to digest, such as egg custard; eat more fresh vegetables, actively supplement nutrients, especially high-quality protein, to improve their immunity and strengthen their body; avoid spicy and stimulating food.
V. Personal insight
Lymphatic duct malformation consists of structurally disordered, hyperplastic and dilated lymphatic vessels, which mostly originate from primitive lymphatic sacs and spread all over the circumferential lymphatic tissues. Most patients clinically manifest as soft local masses and the internal fluid is yellowish transparent or celiac, occasionally with blood, but this is not a real tumor. The patient in this case was found to have a right neck mass a year ago and did not receive any medical treatment. He came to the hospital to receive medical treatment because the mass had grown mildly, and through a series of examination results, it was diagnosed as a cervical lymphatic duct malformation with obvious indications for surgery, so he underwent surgery immediately. During treatment, the patient was very compliant and always followed the doctor’s orders for review, so the treatment was effective. This shows that the patient’s active cooperation in medical treatment is beneficial in controlling the disease. In addition, it is important not to be overly alarmed or ignore the symptoms of discomfort, but to go to the hospital in time to avoid delays.