Mediastinal Lymphangioma of the Adult: Case Report and Literature Review

Introduction: Mediastinal lymphangiomas are rare, benign vascular malformations of the lymphatic system that are seldom diagnosed in adults. Due to their varied clinical presentation and heterogeneous imaging characteristics, they pose a significant preoperative diagnostic challenge, frequently mimicking other mediastinal masses. Materials and Methods: We conducted a thorough search of the PubMed/MEDLINE, PubMed Central, and Google Scholar databases. We included articles from 2000 to 2026. Our search yielded 150 articles, out of which we selected 45 articles. Inclusion criteria were strictly limited to adult patients with a solitary mediastinal lymphangioma. Cases involving diffuse systemic lymphangiomatosis, mixed histological features such as lymphangiomyomas or hemangiolymphangioma or studies on pediatric populations were explicitly excluded from the analysis. We also reported a case of mediastinal lymphangioma in a 42-year-old patient, which was surgically resected at the "Marius Nasta" National Institute of Pneumology in Bucharest, Romania. Case Description: An asymptomatic 42-year-old male presenting with exertional chest discomfort following minor trauma demonstrated a lower left hemithorax opacity on chest X-ray. Imagistic studies revealed a 13 × 9 × 6 cm cystic mass in the left supradiaphragmatic costophrenic recess. The patient underwent a complete radical excision. The postoperative recovery was uneventful. Histopathology confirmed a benign cystic mediastinal lymphangioma. Conclusions: Adult mediastinal lymphangiomas are rare entities that require a high index of clinical suspicion. While advanced cross-sectional imaging is invaluable for delineating their characteristics, definitive diagnosis relies on histopathological confirmation. Complete surgical resection, increasingly performed via minimally invasive approaches or standard thoracotomy, remains the therapeutic gold standard, offering an excellent long-term prognosis with virtually no risk of recurrence. For inoperable cases, several non-surgical approaches are available.