Cine Loops in Ultrasonographic Verification of Acquired Lymphatic Malformation (Lymphangioma) of the Neck Associated with Musical Instrument (Violin) Play: A Case Report

Lymphatic malformation (LM) is a rare pathology that is predominantly congenital. However, an increasing number of published cases clearly demonstrate the possibility of developing acquired LM, mainly because of trauma. Causes of injury can include dental restorations in the oral cavity, repetitive surgeries, and even chronic trauma from playing musical instruments. This article presents the case of a 32-year-old female with an acquired lymphatic neoplasm of the neck that developed because of many years of violin playing. Clinical preoperative photography, gray scale and color Doppler ultrasonography data, two ultrasound videos (cine loops), a specimen of the excised mass, and histopathological images are presented. Thus, this paper confirms the possibility of developing acquired LM in the neck region. The fact that the LM developed to its current size by the patient's 32nd year of life, in addition to the patient’s musical history, confirms that the development and growth of this acquired LM required time, namely years of playing a violin. Also, two ultrasound videos clearly demonstrate the capabilities of this dynamic examination for verifying this rare pathology. Ultrasound videos show the ability of this lymphatic neoplasm to compress and reduce in size by 2 times. Since LM is a term that refers to a developmental defect of the lymphatic system, we suggest using the term "lymphangioma" for acquired lymphatic formation (i.e., lymphatic neoplasm).