I chose to look into cystic hygromas. I found a rare case of a large anterior cervical cystic hygroma. The majority if cystic hygromas are found on the posterior/occipital calvarium at the midline. typically the prognosis for CH are good to guarded. The case study listed the following prognosis below
Prognosis: Widely disparate prognoses accompany cystic hygromas. These are dependent on genetic associations and the timing of discovery . According to Thomas30, the prognosis should be divided into four categories:
1) first trimester, normal karyotype: good;
2) first trimester, abnormal karyotype: poor;
3) second trimester and early third: poor to guarded; and
4) mid to late trimester: good.
Very large masses may compromise the airway by extrinsic pressure resulting in death. To avoid this outcome, early tracheostomy is required . Although these masses usually grow slowly, they may suddenly increase in size secondary to hemorrhage or trauma or because of a viral infection when large amounts of lymphatic fluid are produced from the lymphoid follicles in the cyst wall . Other reported clinical manifestations include fascial nerve paralysis, dysphagia, or other feeding problems . Chylothorax and chylopericardium may occur as complications of mediastinal involvement11. Spontaneous regression during uterine life is also possible, especially in fetuses with Turner or Noonan’s syndrome and this has been used as explanation for the webbed neck seen in children with these conditions10, . The prognosis for hydrops fetalis is dismal .
Unfortunetly this baby with the anterior CH did not survive. He underwent surgery to remove 3/4 of the mass, but it quickly refilled. It even spread to his under eyelids. Later the hygroma ruptured and blocked his airway. The image below is from one of his ultrasounds. The hygroma was originally found at the 20 week scan.
https://sonoworld.com/TheFetus/page.aspx?id=1096
I think this is a modified coronal view of the face and the mass is below his neck.
DIfferentials for CH would be a goiter if anterior, teratoma or cephalocele.
There is a link between CH and chromosomal abnormalities like 18,19,20, and alcohol use.
The risk of recurance in further pregnancies is rare, they are associated with a normal karyotype and can be inherited as an autosomal recessive trait.
enlarged CM, hypoplasia of cerebellar vermis & cerebellar separation
