Vascular lesions of the ulnar upper extremity are predominantly lymphatic malformations

Introduction:
Lymphatic malformations are a common vascular anomaly in the paediatric population. Although the most frequent location is the cervical region, they can appear in any location where lymphatic tissue is present. We are expanding the research of the locoregional distribution patterns of these lesions in the upper extremity previously published by our colleagues in Hospital La Paz in Madrid, Spain.

Material and methods:
We reviewed the medical records, radiological images, and clinical photographs of 12 patients with upper extremity lymphatic malformation that were assisted in the University Hospital of Łódź, Poland, and compared them with a Spanish group from La Paz University Hospital, Madrid. The locoregional distribution of the lesions, treatment applied, and clinical course were assessed. Statistical analysis of the collected data was performed with STATA version 15.0 (StataCorp).

Results:
Eleven of the 12 patients (92%) presented an ulnar distribution pattern of the lymphatic malformation, while one (8%) presented a radial distribution pattern. The patient with radial distribution pattern had the lesion located proximally in contrary to the Spanish one with the radial lesion located distally. One of the patients (8%) presented some complication associated with the lymphatic malformation, such as pain/haemorrhage. Ultrasound-guided sclerotherapy was performed in 8 patients (67%), whereas 3 of the patients (33%) underwent a surgical excision. No differences were found in clinical presentation or evolution between patients with ulnar and radial distribution.

Conclusions:
Upper extremity lymphatic malformations characteristically follow an ulnar distribution pattern, although the radial territory may also be affected. When diagnosing a patient with vascular lesion on the ulnar side, the differential diagnosis can start with lymphatic malformation, while on the radial side with other pathologies. A detailed characterisation of these patterns may contribute to a better and earlier diagnosis of the pathology.