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Published on: May 1, 2015
Natural History of Fetal Non-Nuchal Lymphatic Malformations: A Single Center Retrospective Study
Yada Kunpalin1, Dilkash Kajal2, Lennart Van der Veeken1
1Department of Obstetrics and Gynecology, Fetal Medicine Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Objective:
To document the natural history and complications of second- and third-trimester non-nuchal lymphatic malformations (LM) and identify predictors of these complications.
Methods:
We conducted a single-centre retrospective review of fetuses diagnosed with LMs between January 2015 and January 2024. Lesion size was quantified using the lymphatic malformation volume ratio (LVR): LVR = 0.523 x width x length x height (cm3) / head circumference (cm). Outcomes and LVR growth trends were analyzed using Student's t-test and a linear mixed-effects model.
Results:
Eighteen cases were included (10 cervical, 8 axillary). Uncomplicated cervical LMs grew at 0.3 cm2/week (p < 0.001). Intralesional bleeding (n = 3) was associated with LVR > 11 cm2 and significantly higher growth rates (2.6 vs. 0.3 cm2/week; p = 0.005). All cases with LVR > 5 cm2 required subsequent tracheostomy after birth. Axillary LMs grew at 0.21 cm2/week. One case with bleeding had LVR 4.4 cm2. Median LVR was significantly lower in vaginal deliveries compared with complicated births (2.0 vs. 7.3 cm2; p = 0.03). All LVR > 4 cm2 led to delivery complications.
Conclusion:
Higher LVR predicts haemorrhage and airway intervention in cervical LMs, and delivery complications in axillary LMs. These exploratory observations warrant confirmation in larger prospective cohorts.
