Ultrasound-guided sclerotherapy for benign non-thyroid cystic mass in the neck

Abstract

Surgical excision has traditionally been the treatment of choice for benign non-thyroid cystic neck masses, including lymphatic malformation, ranula, branchial cleft cyst, thyroglossal duct cyst, and parathyroid cyst. However, there is a tendency toward recurrence after surgery, and surgery may be accompanied by complications, including nerve injuries, vascular injuries, and scar formation. Ultrasound-guided sclerotherapy using various agents has been challenged and successfully applied as an alternative treatment for benign non-thyroid cystic neck masses. This report reviews the available sclerosing agents and describes the applications of sclerotherapy to the treatment of benign cystic masses in the neck.

Keywords: Cysts; Neck; Picibanil; Sclerotherapy; Ultrasonography.

Figure 1.. A 54-year-old man with a macrocystic lymphatic malformation treated with ethanol.

A. Ultrasonography reveals a large cystic mass in the right supraclavicular area. B. After treatment with ethanol, the cystic mass decreased markedly, resulting in a small echogenic lesion (arrows).

Figure 2.. A 17-year-old girl with a plunging-type ranula treated with OK-432.

A. Computed tomography reveals a lobulated cystic mass in the left submandibular space (arrows). B. Ultrasonography reveals an insinuating septated mass (arrows) that herniates from the sublingual space into the left submandibular space through the mylohyoid muscle (black arrowheads). The herniating tract (white arrowheads) between the sublingual space and the submandibular space is seen as an echogenic tubular structure. C. After three treatments with OK-432, the lesion disappeared completely.

Figure 3.. A 52-year-old woman with a left tonsillar cancer.

Computed tomography reveals a cystic mass with septation (arrowheads) in left level II.

Figure 4.. A 30-year-old woman with a thyroglossal duct cyst.

A. Computed tomography reveals a cystic mass (arrow) at the anterior and inferior aspects of the hyoid bone. B. Ultrasonography reveals a cystic mass. C. After the treatment with ethanol, the lesion decreased in size.

Figure 5.. A 63-year-old woman with a parathyroid cyst.

Transverse (A) and sagittal (B) ultrasonography reveals a lobulated pure cystic mass (arrows) in the inferior aspect of the left thyroid gland. After treatment with ethanol, the lesion disappeared completely.