A 2-year-old boy has a soft, multilobulated swelling in the right posterior triangle of the neck present since birth. It is painless, compressible, brilliantly transilluminant, and enlarges during respiratory infections. What is the most appropriate first-line treatment?

• A Intralesional sclerotherapy ✓
• B Immediate radical surgical excision
• C Systemic corticosteroids alone
• D Radiotherapy

Explanation

Cystic hygroma is a congenital lymphatic malformation, typically in the posterior triangle, that transilluminates brilliantly and enlarges with intercurrent infection. Intralesional sclerotherapy with agents such as OK-432, bleomycin, or doxycycline is now preferred first-line treatment because these lesions insinuate between vital neurovascular structures, making complete excision difficult and recurrence-prone. Radiotherapy is obsolete, and steroids alone are insufficient for macrocystic disease.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.