Reason: Follow up: assess status of extensive chest, neck, bilateral upper extremity lymphatic/venous malformation (possible CLOVES syndrome variant). History: Chest wall involvement with persistent retractions, growth retardation. LUNGS AND PLEURA: Bibasilar subsegmental atelectasis is present. A few subcentimeter nonspecific pulmonary nodules are again present, the largest which is in the right lower lobe (series 6, image 34) measuring up to 6 mm.MEDIASTINUM AND HILA: The cystic, multiloculated right axillary mass extends into the upper mediastinum involving the bilateral apical spaces, as well as the posterior mediastinum adjacent to the descending thoracic aorta. The anterior mediastinum appears uninvolved. The visualized airway is patent.CHEST WALL: There is a T2 hyperintense, T1 hypointense cystic, extensive mass measuring approximately 5.6 x 7.2 x 14.7 cm, previously 9.4 x 5.2 x 14.0 cm containing multiple septations/loculations with its epicenter in the right axilla extending down the right arm, and involving the right chest wall, and right cervical region, consistent with lymphangioma. Layering material within the cystic spaces could represent proteinaceous debris or blood product. The septations demonstrate enhancement on post contrast images. There is a redemonstration of a mild deformity of one of the right midthoracic ribs (series 601, image 32). There is a smaller, multi-septated cystic left axillary mass measuring approximately 7.2 x 2.9 x 7.5 cm previously 4.7 x 2.1 by 5.1 cm with similar characteristics consistent with lymphangioma.UPPER ABDOMEN: No significant abnormality.
1. Multiple lymphangiomas are again present. The largest is centered in the right axilla with extension into the into the right arm, neck, and mediastinum and has slightly decreased in size compared to the prior examination2. Pulmonary basilar atelectasis are nonspecific subcentimeter pulmonary nodules.