Prenatal detection and management challenges of a huge cystic hygroma of the neck in a resource-constraint setting: A case report

Introduction and importance: Cystic hygroma is a benign congenital malformation of lymphatic and blood vessels, with an incidence of 1 in 6000 live births. Most cases are associated with genetic syndromes and can compromise fetal viability. Due to its rarity, comprehensive data is limited, mainly relying on case reports.

Case presentation: A 21-year-old pregnant woman at 27 weeks' gestation presented to triage with abdominal pain. Abdominal ultrasound revealed a single living female fetus with an estimated fetal weight of 734 g and a complex cystic mass causing hyper-extension of the neck. The pregnancy was terminated given the poor prognosis. Histopathology of the mass confirmed it to be a cystic hygroma.

Clinical discussion: In limited-resource settings, management of huge cystic hygromas often necessitates termination of pregnancy due to a lack of sufficient resources for complex interdisciplinary interventions for the mother and infant after birth. In such cases, focus should be shifted toward promoting shared decision-making and sensitive patient counseling.

Conclusion: Cystic hygromas that are diagnosed prenatally generally have a poorer prognosis than those diagnosed after birth. The management of cystic hygramas, particularly those diagnosed prenatally, represents a persistent challenge in low-resourced settings. Counseling and treatment recommendations must be tailored based on tumor characteristics, the expected prognosis, and the feasibility of medical or surgical intervention in a given clinical environment.