School of Medicine and Health Sciences Poster Presentations

Title

Do Distinguishing Imaging Characteristics Exist Between Plunging Ranulae and Cervical Lymphatic Malformations?

Document Type

Poster

Abstract Category

Clinical Specialties

Keywords

Otolaryngology, Pediatrics, Plunging Ranula, Lymphatic Malformation, Diagnostic Imaging

Publication Date

Spring 5-1-2019

Abstract

Introduction: Lymphatic malformations (LM) are congenital anomalies of the lymphatic system that present as cystic masses, while plunging ranulae (PR) are mucus extravasation cysts of the sublingual gland (SLG) that plunge below the mylohyoid muscle. LM and PR are managed differently, with sclerotherapy and SLG excision respectively. Pre-operative differentiation between LM and PR is challenging, requiring intraoperative aspiration for definitive diagnosis. Objectives: The primary objective of this study was to determine if LMs and PRs demonstrate unique ultrasound imaging (US) or magnetic resonance imaging (MR) characteristics that would enable reliable pre-operative differentiation in a pediatric population. Methods: Imaging and clinical features of PRs treated at our institution between 1/1/2008 and 8/1/2018 by the otolaryngologist or interventional radiologist were compared to a cohort of cervical LM's to determine if distinguishing radiologic characteristics exist. The following characteristics were compared of pre-operative imaging: complexity of fluid on US, unilocular fluid body on US, Hyperintensity on T2-weighted MR, involvement of SLG on MR, breaching of mylohyoid plane on MR, “Tail Sign” on MR, and diffusion study on MR. This is a descriptive study since the rarity of the condition prevented statistical analysis. Results: Fifteen PR patients were identified: 3 US, 6 MRI, and 1 MR diffusion study were available. Nine submandibular LM patients were identified: 6 US, 6 MR, and 2 with MR diffusion studies were available. Both PR and LM US displayed complex and simple fluid behavior. PRs were unilocular, while LMs were unilocular or multilocular. PR and LM were uniformly hyperintense on T2 Fat Saturated MR. PR always communicated with SLG, while LM did or did not. Both PR and LM can cross mylohyoid muscle plane. Both PR and LM can demonstrate a “tail-sign”. Both PR and LM demonstrate diffusion on imaging. Discussion: Definitive distinguishing imaging criteria between PR and LM were not found in this study, although trends were noted. While imaging studies are useful to determine the extent of disease and to exclude other anomalies, this study shows that differentiation of LMs versus PRs is difficult without aspiration of fluid.

Open Access

1

Comments

Presented at Research Days 2019.

This document is currently not available here.

Share

COinS
 

Do Distinguishing Imaging Characteristics Exist Between Plunging Ranulae and Cervical Lymphatic Malformations?

Introduction: Lymphatic malformations (LM) are congenital anomalies of the lymphatic system that present as cystic masses, while plunging ranulae (PR) are mucus extravasation cysts of the sublingual gland (SLG) that plunge below the mylohyoid muscle. LM and PR are managed differently, with sclerotherapy and SLG excision respectively. Pre-operative differentiation between LM and PR is challenging, requiring intraoperative aspiration for definitive diagnosis. Objectives: The primary objective of this study was to determine if LMs and PRs demonstrate unique ultrasound imaging (US) or magnetic resonance imaging (MR) characteristics that would enable reliable pre-operative differentiation in a pediatric population. Methods: Imaging and clinical features of PRs treated at our institution between 1/1/2008 and 8/1/2018 by the otolaryngologist or interventional radiologist were compared to a cohort of cervical LM's to determine if distinguishing radiologic characteristics exist. The following characteristics were compared of pre-operative imaging: complexity of fluid on US, unilocular fluid body on US, Hyperintensity on T2-weighted MR, involvement of SLG on MR, breaching of mylohyoid plane on MR, “Tail Sign” on MR, and diffusion study on MR. This is a descriptive study since the rarity of the condition prevented statistical analysis. Results: Fifteen PR patients were identified: 3 US, 6 MRI, and 1 MR diffusion study were available. Nine submandibular LM patients were identified: 6 US, 6 MR, and 2 with MR diffusion studies were available. Both PR and LM US displayed complex and simple fluid behavior. PRs were unilocular, while LMs were unilocular or multilocular. PR and LM were uniformly hyperintense on T2 Fat Saturated MR. PR always communicated with SLG, while LM did or did not. Both PR and LM can cross mylohyoid muscle plane. Both PR and LM can demonstrate a “tail-sign”. Both PR and LM demonstrate diffusion on imaging. Discussion: Definitive distinguishing imaging criteria between PR and LM were not found in this study, although trends were noted. While imaging studies are useful to determine the extent of disease and to exclude other anomalies, this study shows that differentiation of LMs versus PRs is difficult without aspiration of fluid.