Lymphatic Malformation :: Nationwide Children's Hospital

Lymphatic Malformation

Interventional radiologists at Nationwide Children’s Hospital have created an internationally-recognized program for providing innovative, successful minimally-invasive treatment of lymphatic malformations. For more than 20 years, our radiology team has been refining the treatment process, especially in the eye, abdomen, head and neck.

Transition of care

Dr. Shiels dedicated his life to advancing the field of radiology in order to provide the best care to children in our community, across the country and around the world. As we remember and celebrate his work, we will remain ever-grateful for his passionate mentorship of our radiology team and staff – some of whom have worked side by side with Dr. Shiels for more than a decade. Everything Dr. Shiels learned over his career, he taught to and instilled in his staff including his revolutionary advancements in interventional radiology and ultrasound; treating lymphatic malformations; bone tumor ablation, aneurysmal bone cyst and salivary gland ablation.  His passion inspires the entire team to continue delivering the best possible care to children everywhere and his legacy will live in the advancements we continue to make here at Nationwide Children’s.

Our team truly is the lymphatic malformation expert because they have developed and perfected the following procedures:

  • A dual-drug catheter based treatment of macrocystic (large) lymphatic malformation, which is a technique using a new coaxial catheter system to access the eye, head, neck and the extremities.
  • The first, successful minimally-invasive "foam" injection treatment for microcystic (small) lymphatic malformation, which was long considered to be untreatable using traditional injection treatments.
  • A microcystic venolymphatic malformation (both lymphatic vessels and veins) treatment using another foam injection with a drug called "bleomycin."
  • An outpatient macrocystic lymphatic malformation treatment with a novel dual-drug system.

If you are interested in minimally-invasive treatment options, call our Interventional Coordinator at (614) 722-2375 to set up a consultation with an Interventional Radiologist. Our team works with other specialists in a multidisciplinary Vascular Anomalies and Hemangioma management team, and consultations with surgeons and dermatologists can also be coordinated.

What is a lymphatic malformation?

A lymphatic malformation is the result of abnormal formation and development during fetal development (malformation) of the otherwise normal lymphatic vessels in the body, usually in one area of the body (neck, chest, abdomen or extremity). Lymphatic malformation, previously known as lymphangioma, is a common vascular malformation, representing approximately five percent of all benign (harmless) tumors. A lymphatic malformation is a lump (mass) of tissue containing bubbles of fluid, known medically as “cysts”.

Are there different types of lymphatic malformations?

There are two main types of lymphatic malformations based on cyst size detected with medical imaging:

  1. large cysts (macrocysts) are called "macrocystic"
  2. small cysts (microcysts) are called "microcystic"

The size, location and how fast a lymphatic malformation develops determines how it will affect the body. Some lymphatic malformations are visible at birth (cysts full of fluid causing a large mass to be seen or felt). Other lymphatic malformation cysts fill up with fluid later in life and may be detected for the first time later in a child’s life (or even when an adult).

Pediatric surgeons, otolaryngologists, ophthalmologists, oculoplastic surgeons, neurosurgeons, urologists and other surgeons now offer their patients these minimally-invasive treatments as alternatives to more extensive and potentially deforming surgical procedures. The case studies below illustrate the dramatic impact these treatments can make in a patient's life.

Case Study 1: Lymphatic Malformation of the Neck, Shoulder and Chest

In the first few hours of life, Hayden underwent a CT scan that clearly illustrated for the pediatric surgeon in Kentucky the extent of the mass, previously seen on a prenatal ultrasound.
The mass involved the left neck, shoulder and the entire length of the left chest wall. Surgical mapping indicated extensive surgical removal involving major nerves and vital structures, resulting in an up to 50 percent chance of recurrence.
  [read more...]

After consultation with The Lymphatic Malformation Center at Nationwide Children's Hospital, the surgeon decided against operative removal and transferred Hayden to Nationwide Children's for definitive interventional radiological treatment.
Following the five-hour trip from southern Kentucky, Hayden, age 6 months, underwent his first two-hour procedure that ablated more than 95 percent of the lymphatic malfmormation, through a 2 mm opening in the skin.
Hayden came back six months later to complete his second procedure, which only took 60 minutes, and was released to go home with only a Spiderman bandaid for a dressing, and no remaining cysts for treatment.

Case Study 2: Orbital Lymphatic Malformation

Jordan, age 13, dreamed of being able to do simple things that his friends enjoyed, such as running track, playing baseball and rollerblading, to name a few. Since the age of 3, Jordan had undergone treatment for a left orbital lymphatic malformation.
Each intervention provided little success at relieving his proptosis or recurrent symptoms. By age 13, when his lymphatic malformation flared up, it sent him to the hospital with a severe headache, visual loss and bradycardia.
  [read more...]

Surgeons operated to attempt removal of the mass, drained the cystic spaces and consulted with experts around the country for other surgical options. One leading, east coast pediatric teaching center suggested that if additional treatment were attempted, they anticipated Jordan would have a three to four month inpatient stay, and the high risk of recurrence.
Before proceeding with additional surgical options, Jordan's oculoplastic surgeon in Kansas placed his case on the Internet, for fellow oculoplastic surgical opinions around the country. Dr. Kenneth Cahill, Oculoplastic Surgeon at Grant Medical Center and Nationwide Children's Hospital, read the e-mail and recommended that Jordan come to Nationwide Children's for treatment.
Following Dr. Cahill's recommendation, Jordan's surgeon followed up with his family, who opted to make the trip and bring their son to Nationwide Children's Hospital. Jordan needed just one interventional radiology procedure, with a 23-hour inpatient stay.
As a result of the procedure, Jordan no longer has proptosis and has no recurrence of his bradycardia. At age 13, Jordan is realizing his dream of enjoying the simple things. Now his biggest physical complaint is sore leg muscles from running track.

Featured Physician

James Murakami, MD
James Murakami,

Personally trained by Dr. Shiels, James Murakami, MD, MS, will be carrying on the care of Dr. Shiels' patients. A faculty member at Nationwide Children's for more than 15 years, Dr. Murakami has interventional radiology interests focusing on sclerotherapy of vascular malformations and benign cysts of the head and neck, orbits, and bones.

Learn more »

featured video

Victoria's Story - Removing a Lymphatic Malformation
Jordan's Story - Orbital Lymphatic Malformation
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