PMC4629304_01
42-year-old female with a history of chronic iron deficiency anemia and menorrhagia for several years and later diagnosed with cystic lymphangioma of the small bowel mesentery. Transabdominal ultrasound (a) sagittal and (b) transverse scans demonstrate a bulky uterus with a subserosal fibroid (white arrows) seen in both sagittal and transverse planes.
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F1
Ultrasound was technically difficult, but demonstrated multiple fibroids [Figure 1] and a simple cyst within the left ovary.
42-year-old female with a history of chronic iron deficiency anemia and menorrhagia for several years and later diagnosed with cystic lymphangioma of the small bowel mesentery underwent pelvic ultrasound for investigation of menorrhagia and was found to have a complex cystic right adnexal mass. Transabdominal ultrasound demonstrates a cystic lesion with numerous thin septae (curved arrows) and good through transmission (straight arrows).
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F2
The right ovary was not visualized, but ultrasound demonstrated a complex cystic right "adnexal mass" measuring 9.7 x 5.2 x 6.3 cm that was presumed to originate from the right ovary [Figure 2].
42-year-old female with a history of chronic iron deficiency anemia and menorrhagia for several years and later diagnosed with cystic lymphangioma of the small bowel mesentery. Axial T2 images (a and b) demonstrate tethering of right ovary (arrows) to the uterus posteriorly.
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F3
T1 bright foci within the left ovary suggestive of an ovarian endometrioma, as well as a dilated left fallopian tube with T1 high signal consistent with a hematosalpinx. The right "adnexal lesion" was only partially visualized on the pelvic MRI, but was deemed to originate from the abdomen rather than the ovary, which was tethered to the uterus [Figure 3].
42-year-old female with a history of chronic iron deficiency anemia and menorrhagia for several years and later diagnosed with cystic lymphangioma of the small bowel mesentery. (a) Coronal fast imaging with steady-state precession (FISP) demonstrates a multiloculated cystic lesion with numerous septae (straight arrows), lacking mass effect. (b) Sagittal T2 (13 months later) of lesion, shows increase in size of lesion with thin-walled septae (straight arrows) and insinuating around the mesenteric vessels (curved arrow). Note the uterine fibroid with evidence of cystic degeneration (hollow arrow).
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F4
T2 signal and low T1 signal and measuring 17.6 x 6.8 x 8.7 cm. The lesion insinuated around adjacent vessels within the small bowel mesentery and demonstrated multiple thin internal septations [Figure 4a]. A 13-month follow-up MRI examination showed that the lymphangioma had increased in size compared to the initial examination, measuring 17.6 x 8.4 x 11.4 cm and extending from the uncinate process of the pancreas to the uterine fundus [Figure 4b].
42-year-old female with a history of chronic iron deficiency anemia and menorrhagia for several years and later diagnosed with cystic lymphangioma of the small bowel mesentery. Corresponding axial T1 (a) in-phase and (b) out-of-phase MR images demonstrate the cystic lymphangioma (straight arrows) with signal intensity loss on the out-of-phase image (b) compared to the in-phase image, indicative of microscopic lipid content of chylous fluid.
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F5
T1 in-phase sequence, consistent with microscopic lipid content. The signal intensity on T1 in-phase was 78.4 and on T1 out-of-phase was 56.2, thus denoting a 28.3% signal intensity loss between phases. This finding is compatible with the presence of chylous fluid and is a very suggestive feature of a lymphangioma [Figure 5].