Beckett's Lymphangioma

*We had a medical issue arise with Beckett (he's fine though!) and I'm going to interrupt our regularly scheduled programming to give some details here to keep our family and friends informed.*

Just over a month ago Beckett developed a swollen area on the right side of his neck.  It looked just like the typical toddler pudgy neck or double chin, except it was just on one side.  He had a little cold so I assumed it was a swollen lymph node or something, and we weren't worried about it.  After a few days it hadn't gone away so we  took him to the pediatrician to get it checked out.

Cute kid, huh? :)  You can see the bulge here, if you look for it.  It does not bother him in the slightest, in fact he has no idea it's even there.

The pediatrician said it wasn't a swollen lymph node and was a bit stumped as to what it would be.  She wasn't concerned about it per se, but did think we should figure out what it was.  She ran blood work (to see if it was due to an infection, and also to rule out cancer).  The blood work all came back fine, and the next step was getting an ultrasound done on it.  I'm not sure what was really learned from the ultrasound, but we were then referred to a pediatric surgery group.  The pediatric surgeon suspected it is something called a lymphangioma (also known as a cystic hygroma or lymphatic malformation), which is a rare non-malignant mass consisting of fluid-filled spaces thought to be caused by the abnormal development of the lymphatic system. They are almost almost always found in the neck and are usually detected prenatally and apparent at birth, but can occasionally appear in children up to two years old after the onset of a cold (when the immune system--which includes the lymphatic system--is in high gear).  The latter is what happened in Beckett's case.

The surgeon ordered an MRI, which we did (unfortunately it involved putting Beckett under general anesthesia, but thankfully he did fine with it) and it confirmed the lymphangioma diagnosis and gave the surgeon a detailed sense of what to expect when he were to go in to surgically remove it.  Side note: the reason we can't just let it be (since it doesn't bother him) is it can get infected, and also that as it continues to grow it can interfere with his airway or other structures.  Thankfully the MRI showed that the cyst is "not very involved"--meaning it is not entangled with major veins, arteries, muscles, and nerves, although it is in close proximity to all that stuff.  Bottom line: the neck is just not an ideal place to operate on.  We asked the surgeon if there were any other options besides surgery and in short, his answer was no.  He said Beckett's case is a good candidate for surgery and likely would have a really good outcome, but the surgery comes with some risks and the main one is a small chance of nerve damage to the arm.  Plus he'd have a pretty sizable scar along his neck.

For a few reasons I wasn't really loving the surgeon, and we decided if we're going to do this we might as well do it all the way and go ahead and seek a second opinion.  I got in touch with my best friend Laura's oldest sister who is a surgeon in the area and asked if she had any suggestions, and she got back to me right away with a pediatric surgeon at the big children's hospital in our city, saying he is "phenomenal."  

We met with him this past Wednesday and right from the start I felt a million times better about him than the previous surgeon.  And that was even before he gave his recommendation, which was that he did not need surgery (!!!!!).  He basically said surgery is an outdated approach to dealing with lymphangiomas and that they are now able to treat them with a minimally-invasive approach called sclerotherapy, which is performed by a radiologist who pokes the cyst and drains it, then injects and flushes it with an antibiotic to cause inflammation in the outer wall of the cyst, collapsing those vessels to prevent it from recurring.  Another side note: the chance of recurrence is one of the problems with these things--if you don't get the whole outer wall (either by attacking it directly with antibiotics via sclerotherapy or by attempting to remove it surgically)--the cyst can come back.  But it's our understanding that there isn't reason to think the chance of recurrence would be more or less likely with sclerotherapy versus surgery, and sclerotherapy has the obvious benefit of avoiding major surgery.  And if it were to come back, doing sclerotherapy a second time would be no big deal whereas operating on his neck a second time would be "a mess."

Our sweet boy waiting on the doctor on Wednesday.

These pictures below show the mass/cyst, which has grown substantially in the past week or so after being hardly noticeable for a few weeks.

 How handsome is he? :)  He's been such a trooper through all of this.  And he still has no idea anything is even going on.

So, we met with the chief of radiology at the children's hospital this morning and Beckett is scheduled for the sclerotherapy procedure on Monday.  Needless to say, we are now big fans of academic-based children's hospitals, which are at the forefront of innovation and at least in this case, superior to the private-practice group.  And of getting a second opinion!

Anyway, so Monday is the big day.  The procedure will be done under general anesthesia, but Beckett will go home right afterward with simply a band-aid to show for this whole ordeal.  We can hardly believe it!  We are so thankful for the Lord's provision through all of this, and after spending time in waiting rooms at a children's hospital, we are more grateful than ever for the good health of our children.  But please to join us in praying for Beckett's procedure Monday--for no fear and for full and complete healing.

And speaking of waiting rooms, here's one last picture just for fun.

Yes that is Beckett dressed as a dinosaur and no I don't have an explanation as to why.