Lymphatic Leaks: Decoding Retroperitoneal and Inguinoscrotal Lymphangiectasia through Imaging

Abstract Retroperitoneal lymphangiectasia is a very rare benign lymphatic malformation characterized by abnormal enlargement of lymphatics. Lymphatic malformation in the inguinoscrotal region is rare, occurring in about 0.2% of patients with groin and scrotal swellings.1 USG and CT scan are the commonly used imaging modalities to diagnose, evaluate and see extent of intra-abdominal lymphangiectasia. It appears as multilocular cystic non enhancing lesion. They are trans fascial and involve multiple compartments. The diagnosis is confirmed by aspiration of chylous fluid.2-7 We present a case of a 25-year-old male with a retroperitoneal lymphatic malformation that was causing right scrotal swelling, which was diagnosed as retroperitoneal low flow vascular malformation i.e. retroperitoneal lymphangiectasia and right inguinoscrotal lymphangiectasia by laboratory tests and Ultrasonography and CECT. Retroperitoneal and inguinoscrotal lymphangiectasia is a type of slow flow lymphatic malformation with clinical presentation of scrotal swelling. Ultrasonography and cross-sectional imaging are helpful in diagnosis and differentiation of these lesions from hernia/ varicocele and filariasis. Further CT and MRI help with the anatomical extent of the lesion.1