A refractory right cervical mediastinal lymphangioma with medication and insertion of a Denver shunt

The Denver shunt is used for persistent chylothorax as a pleuroperitoneal shunt. Insertion of a Denver shunt was attempted in the current case involving a 3-year-old male with a refractory right cervical mediastinal lymphangioma. He was medicated with Eppikajutsuto® (0.65 g/kg) and underwent a Denver shunt for volume reduction of the cervical cyst to prevent airway obstruction. However, revision surgery for hemorrhage in the lymphangioma revealed that the tip of the shunt catheter had penetrated the cyst wall. The rounded tip of the catheter was placed back into the cyst. Oral administration of sirolimus (1 mg) was added. The Denver shunt was removed due to a catheter infection and administration of sirolimus was temporarily stopped because of an elevated blood concentration. Six months postoperatively from the third operation, neck swelling was negligible and radiologic findings showed complete regression of the lymphangioma.