Lymphoscintigraphic manifestations of Hennekam syndrome--a case report

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.

Hennekam syndrome presenting as nonimmune hydrops fetalis, congenital chylothorax, and congenital pulmonary lymphangiectasia

We report a female infant with congenital lymphedema, facial anomalies, intestinal lymphangiectasia consistent with a diagnosis of Hennekam syndrome. At birth the patient presented with severe respiratory distress due to nonimmune hydrops fetalis, a congenital chylothorax (CC), and pulmonary lymphangiectasia. Hydrops fetalis may be present in newborns with the Hennekam syndrome. Lymphoscintigraphy can be useful in explaining pleural-pulmonary involvement of this generalized lymph vessel malformation syndrome.

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.

Severe lymphedema, intestinal lymphangiectasia, seizures and mild mental retardation: further case of Hennekam syndrome with a severe phenotype

We report on an Italian patient affected by severe lymphedema of lower limbs, genitalia and face, intestinal lymphangiectasia, seizures, and moderate mental retardation. He has a flat face, flat nasal bridge, and hypertelorism. We propose that he presents with a severe form of Hennekam syndrome.