Pediatric Mediastinal Lymphatic Malformation: Misdiagnosis Analysis and Literature Review

Abstract

Objectives Mediastinal cystic lymphatic malformation (MCLM) in children is prone to misdiagnosis as cystic teratoma. We compared the clinical and radiologic features between the two diseases and performed a cross-comparison with previous research focused on adult cases. This study aims to identify characteristic pediatric manifestations for the improvement of diagnostic accuracy. Methods We retrospectively studied clinical and radiology data of 12 cases of MCLM and 20 cases of cystic teratomas confirmed by pathology or intervention biopsy. Clinical characters and radiology features (mass location and morphology, density, component, secondary complication) were recorded and compared. We searched published clinical studies related to MCLM in the past decade. We compared the radiology differences between them. Also, a comparison was made between pediatric MCLM cases in our hospital and MCLM cases from the kinds of literature. Results Group comparison in pediatrics between MCLM and cystic teratomas: There were significant age differences (p = 0.036), shape (p = 0.003), DV (p < 0.001), DR (p < 0.001), calcification (p < 0.001), fat (p < 0.001), and typing (p < 0.001) between the two diseases. MCLM cases from literature: A total of 10 studies with 70 patients were eligible for data extraction. Conclusion The lack of internal fat or irregular morphology with minimal DV suggests the diagnosis of MCLM. In pediatric cases, anterior mediastinal diseases are more likely to extend toward the neck, and the persistence of the thymus can complicate component analysis and increase the risk of misdiagnosis. Thus, MRI evaluation is recommended for pediatric MCLM case assessment.