article · International Journal of Surgery Case Reports
Cystic hygroma is a rare congenital lymphatic malformation that typically arises in the head and neck. Although large malformations often cause immediate breathing difficulties, delayed airway obstruction can still happen, particularly in resource-constrained environments where prenatal care and neonatal support are limited. A term infant born in a rural area presented with a large neck mass but remained stable without respiratory distress at birth. After referral to a tertiary facility within 72 hours, imaging showed that the mass displaced the airway without compressing it. However, at three weeks of age, the infant experienced progressive stridor and cyanotic episodes. A multidisciplinary surgical team successfully completed an emergency excision of the malformation, draining 2.3 litres of fluid without requiring a tracheostomy, leading to full recovery.
Even massive congenital neck lesions in newborns can initially appear non-threatening before rapidly worsening. Demonstrating that complex, life-threatening malformations can be safely and completely excised in resource-limited healthcare facilities highlights the vital role of structured referral systems, clinical vigilance, and multidisciplinary surgical capabilities in preventing neonatal mortality.
The abstract does not indicate an application pathway, as it reports a clinical case study describing emergency surgical intervention rather than a commercial product or technical methodology.
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BACKGROUND: Cystic hygroma is a rare congenital lymphatic malformation, typically presenting in the cervicofacial region. While large lesions usually cause immediate respiratory distress, delayed airway obstruction can occur, especially in low-resource settings with limited prenatal care and neonatal support. CASE PRESENTATION: A term male neonate was delivered in a rural setting with a large right cervicofacial mass consistent with cystic hygroma. Despite the lesion's size, he was stable at birth without respiratory or feeding difficulties. He was referred and transported to a tertiary center within 72 h. Imaging confirmed a macrocystic lymphatic malformation displacing but not compressing the airway. At three weeks, he developed progressive stridor and cyanotic episodes. Emergency surgical excision was performed by a multidisciplinary team. The lesion, containing 2.3 l of fluid, was completely removed without tracheostomy. Histopathology confirmed cystic hygroma. DISCUSSION: This case highlights the unpredictable progression of cervicofacial lymphatic malformations. While initially stable, the patient developed delayed airway compromise requiring urgent intervention. In low-resource settings, early recognition and prompt referral, coupled with coordinated surgical response, can lead to successful outcomes even in high-risk neonatal emergencies. CONCLUSION: Giant cystic hygromas in neonates may appear benign initially but can rapidly evolve into airway-threatening emergencies. This report emphasizes the critical importance of early multidisciplinary planning, referral networks, and operative readiness in resource-constrained environments.
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DOI: 10.1016/j.ijscr.2025.111835
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