End-stage renal disease in a patient with congenital lymphangiectasia and lymphedema

Percutaneous drainage and sclerotherapy as definitive treatment of renal lymphangiomatosis

We report the technique and outcome of percutaneous drainage and sclerotherapy as primary treatment of renal lymphangiomatosis. Between January and May 2009, two patients presenting with symptomatic renal lymphangiomatosis were treated in our department by a minimally invasive modality combining percutaneous drainage with repeated sclerotherapy. We retrospectively analysed recurrence, complications and patient satisfaction. In this limited case series, percutaneous drainage and repeated sclerotherapy proved to be safe and effective for treating renal lymphangiomatosis. This procedure provides a minimally invasive option for selected patients, potentially avoiding a surgical procedure and any risk of complications.

Hennekam Syndrome Presentıng Wıth Abdomınal Mass

We report a patient presenting with an abdominal distention and irritiability, who was found to have Hennekam syndrome. A physical examination revealed left sided hemihypertrophy and a mass with undefined margins around the umblical region. Ultrasonography and contrast enhanced computerised tomography revealed a solid heterogeneous mass extending from the parapancreatic region into the mesenteric root and, diagnostic laparotomy was performed. The intestinal walls and the mesentery were found to be diffusely thickened. Histopathological analysis revealed fibrosis along with cystic enlargement of the lymphatic vessels. The patient had left periorbital edema and facial dysmorphism. Non-pitting edema of the abdomen, left arm, left leg, and left labia majora was noted. Laboratory tests showed hypoproteinemia, hypoalbuminemia, and high faecal α-1 anti trypsin. Endoscopic examination revealed milky fluid oozing from the mucosa into the duodenal lumen. Histopathological analysis revealed total villus atrophy and cryptic hyperplasia. We postulate that an enlargement in the intestinal wall could be mistaken for an abdominal mass, and, we present this case of an abdominal mass as a new manifestation of Hennekam syndrome.

Further delineation of Hennekam syndrome

We report four children from four inbred Arab families with varying manifestations of Hennekam syndrome and additional features that have not been previously reported. These include abnormalities of the middle ear, anomalous pulmonary venous drainage, interrupted inferior vena cava, polysplenia, crossed renal ectopia, median position of the liver and multiple cavernous haemangiomas. In addition, in one case lymphoedema was absent and oedema due to hypoproteinaemia appeared at 6 years of age. Since anomalies of the veins and the consequent developmental abnormalities of the lymphatics might lead to alterations in the fluid balance of the embryo, we hypothesize that altered fluid dynamics due to defective vascular and lymphatic development might disrupt critical events in craniofacial morphogenesis resulting in Hennekam syndrome.

Quilotórax recorrente – uma história com 15 anos

The authors describe the clinical case of a 15 year-old adolescent with recurrent bilateral chylothorax leading to multiple hospitalizations. As in other cases described the diagnosis was made on the basis of classical clinical features and characteristic CT scan. Most cases of pulmonary lymphangiectasis, described in the literature, are lethal in the neonatal period. In this case the girl has a reasonable life quality, in spite of multiple hospitalizations. Lower limb lymphedema, facial anomalies (flat face, palpebral edema, tooth anomalies and small mouth) and mild development retardation allow us to consider our case as the first portuguese case of Hennekam Syndrome. Molecular studies will allow, in the future to explain most of the clinical manifestations and to include other patients in the same clinical entity.

Lymphedema-lymphangiectasia-mental retardation (Hennekam) syndrome: a review

The Hennekam syndrome is an infrequently reported heritable entity characterized by lymphedema, lymphangiectasia, and developmental delay. Here we add an additional 8 patients, and compare their findings to the 16 cases from the literature. The lymphedema is usually congenital, can be markedly asymmetrical, and, often, gradually progressive. Complications such as erysipelas are common. The lymphangiectasias are present in the intestines, but have also been found in the pleura, pericardium, thyroid gland, and kidney. Several patients have demonstrated congenital cardiac and blood vessel anomalies, pointing to a disturbance of angiogenesis in at least some of the patients. Facial features are variable, and are chiefly characterized, in a typical patient, by a flat face, flat and broad nasal bridge, and hypertelorism. Facial features are thought to mirror the extent of intrauterine facial lymphedema, or may be caused by lymphatic obstruction that affects the early migration of neural crest tissue. Other anomalies have included glaucoma, dental anomalies, hearing loss, and renal anomalies. The psychomotor development varies widely, even within a single family, from almost normal development to severe mental retardation. Convulsions are common. The existence of 10 familial cases, equal sex ratio, increased parental consanguinity rate (4/20 families), and absence of vertical transmission are consistent with an autosomal recessive pattern of inheritance. It seems likely that most (but not all) manifestations of the entity can be explained as sequences of impaired prenatal and postnatal lymphatic flow, suggesting that the causative gene(s) should have a major function in lymphangiogenesis.