Male, 1 day old, born at 31 weeks gestational age, with neck lesion concerning for venous/lymphatic malformation. A large multiloculated, multispatial, predominantly cystic lesion is redemonstrated within the right neck. The largest cystic components of this lesion are centered at the level of the parotid, parapharyngeal and masticator spaces with extension from the skin surface deep to the level of the pharyngeal mucosa. Components of the lesion infiltrate into the right-sided tonsillar and soft palate tissues, the floor of mouth and submental spaces, the submandibular space, and even into the larynx. The mandible and maxilla are both deformed by this lesion.The cystic components of the lesion are for the most part T2 hyperintense and T1/FLAIR hypointense which would indicate a fairly watery consistency. One smaller medial cystic component demonstrates incomplete suppression on FLAIR images which may imply proteinaceous fluid. The cystic components of the lesion do not enhance and show no accumulation of contrast material. The rim and internal septations show thin enhancement.A cleft palate is noted. Just posterior to the cleft, or perhaps within the cleft, is a lobular soft tissue lesion which demonstrates heterogeneous internal fatty tissue and relative T2 hypointensity. This lesion enhances fairly homogeneously. It is in contact with the adjacent cystic lesion and may therefore represent a solid component of the overall lesion or perhaps a separate lesion.The dominant cystic component of the lesion encroaches upon the right infratemporal fossa and actually indents the floor of the right middle cranial fossa. The lesion just barely contacts the undersurface of the right temporal lobe without significant mass effect and no findings to suggest brain parenchymal edema. The lesion also approaches and may infiltrate the right temporal bone.Otherwise, the brain parenchyma as visualized demonstrates normal morphology for gestational age. No areas of significant parenchymal signal abnormality are seen. There are no findings to suggest acute ischemic injury. No abnormal intracranial collections are seen. No findings to suggest intracranial hemorrhage are demonstrated. The ventricles are normal in size and morphology.The skin of the right neck, overlying the cystic lesion, and continuing into the right scalp, is mildly thickened. This is favored to represent edema rather than diffuse lesional involvement.
Redemonstrated is a large, predominantly cystic lesion occupying multiple right neck spaces. The rim and internal septations of the lesion demonstrate thin enhancement.A relatively more solid lesion with heterogeneous internal fat and fairly homogeneous enhancement is seen at midline in the nasopharynx, just posterior to or within the cleft palate. This lesion abuts the cystic lesion and may be part of it, or may represent a second lesion.The predominantly cystic and widely infiltrative, transspatial characteristics of the lesion support the possibility of a lymphatic malformation. The solid enhancing nasopharyngeal lesion could represent a venous malformation rendering the overall lesion a combined veno-lymphatic malformation, or it could represent a separate, possibly vascular lesion such as a hemangioma. The possibility that the combined cystic and solid lesions represent a teratoma should also be considered but this is felt to be less likely.The lesion encroaches into the right middle cranial fossa, but there is no significant mass effect upon the brain and no evidence of brain parenchymal invasion. Otherwise, assessment of the brain is within normal limits for gestational age. No findings are seen to suggest acute ischemic injury, though if clinical concern exists, a repeat examination in one week's time will increase sensitivity.