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Abstract: In case of malformed lymphatic vessel development or lymphatic vessel occlusion, a cyst is visible on the skin surface of the patient, usually in a single or multiple compartments, each of which varies in size and shape. The patient in this set of cases is a 36-year-old female who came to the hospital after noticing an axillary mass 2 years ago that had recently become increasingly large. The diagnosis of lymphatic duct malformation was made by completing relevant examinations. The surgery was successful and the patient is in good condition after the surgery with no discomfort.
Basic information】Female, 36 years old
Disease Type】Lymphatic Duct Malformation
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of consultation】April 2021
Treatment plan】Surgery (cystectomy) + medication (cefuroxime)
Treatment period】1 week of hospitalization, 1 review in 6 months after surgery
Results】The surgery was successful and the patient has recovered
I. Initial consultation
In the afternoon of April 2021, Ms. Zhao came to the clinic. After careful questioning, we learned that Ms. Zhao had noticed a lump in her armpit two years ago, but she had just given birth to her little girl and thought it was a blockage caused by milk, so she did not pay attention to it. But recently, she found that the lump was getting bigger and bigger, and she felt uncomfortable, so she came to our hospital for treatment. After examination, we found that there was a lump protruding from the right armpit of Ms. Zhao, which was smooth and soft, with obvious fluid fluctuation, unclear boundary and no tenderness.
II. Treatment process
After admission, Ms. Zhao continued to improve ultrasound, computed electron tomography, transillumination test, pathology examination and other related examinations. According to the examination report, Ms. Zhao had a multifocal cystic mass in the right axilla, which had extended to the right hemithorax and the soft tissue part of the abdomen, with high T2WI and extension of the mass to the posterior part of the right SCM and the medial part of the arm. After the clear diagnosis, I communicated with Ms. Zhao in detail about the treatment plan and analyzed the advantages and disadvantages of various treatments, and Ms. Zhao finally chose surgery. Two days after admission, Ms. Zhao underwent cystectomy under local anesthesia, which lasted for more than one hour and the procedure was smooth. Cefuroxime was given to the patient for anti-infection treatment after the operation, and Ms. Zhao recovered well from the wound and did not complain of other discomfort.
III. Treatment results
Ms. Zhao’s surgery was very successful, and postoperative treatment such as pain relief and dressing change for the incision was given. At 1 week postoperative checkup, Ms. Zhao’s incision healed well, with no obvious pain, no redness, swelling, blood and exudate, and clean and dry dressing; all of Ms. Zhao’s vital signs were stable, her mental state was clear, and she was discharged on the 7th postoperative day. At the time of discharge, Ms. Zhao was repeatedly advised to avoid excessive lifting activities of both upper limbs to avoid incisional dehiscence and to come to the hospital for regular review.
IV. Notes
We are glad that the patient’s surgery was very successful and that the patient’s worries were alleviated. After discharge, advise the patient to learn self-examination, pay attention to any new lumps on the body surface or around the surgical site, pay attention to the hygiene of the wound area to avoid infection, and seek medical attention promptly if abnormalities occur; in addition, regular postoperative follow-up should be conducted and reviewed again at 6 months after surgery. It is advisable to eat foods containing high quality protein, high protein and high fiber, more vitamin-rich fruits and fresh green vegetables, such as kiwi, apple, pineapple, cabbage, rape, carrot, cabbage, mushroom, etc.; avoid spicy and stimulating foods, such as onion, garlic, ginger, pepper, chili, etc. Ensure sufficient sleep and avoid strain; maintain a relaxed and happy mood and avoid emotional stimulation such as tension and anxiety.
V. Personal insight
Lymphatic duct malformation is actually a less common type of clinical disease, often a hollow lesion, mostly benign. As in the case of Ms. Zhao in this episode, there are multiple compartmentalized masses, painless and other symptoms. Patients do not need to be overly nervous, seek timely medical attention and actively treat through surgery, which usually will not affect daily work life. In daily life, care should be paid attention to rest, maintain a good state of mind, and actively prevent and control infection. As a general surgeon, patients are advised to review their condition every 6 months so that the doctor can keep abreast of changes and adjust the treatment plan. Patients may have psychological stress such as irritability and anxiety, and family members should communicate and enlighten patients more often to enhance their confidence in treatment.