Hygroma

HYGROMA, hygroma, hygroma gangliioides (from the Greek hygros - moist), is a collective term for tumor-like or nodular formations (as a rule, a hygroma is not a true tumor in the strict sense) that arise during various pathological processes and are characterized by the accumulation of watery fluid (secretion, transudate, exudate, autolytic breakdown products, etc.) anywhere in the tissues, accompanied by the formation of a more or less distinct capsule around it. Thus, a hygroma can be observed in chronic inflammation of mucous bursae (synonyms: bursitis chronica, hydrops bursarum chronicum); among such hygromas, prepatellar hygroma (h. praepatellare, h. bursae praepatellaris) is especially common, for example, in individuals (most often men) engaged in heavy physical labor associated with trauma to the leg (working on their knees), and sometimes also in domestic servants (the English "housemaid's knee"). Chronic (not infrequently tuberculous) tenosynovitis can lead to the development of a hygroma, especially in the area of the hands (the palmar surface of the fingers, the palm, the back of the hand, the wrist, for example, h. carpale - see figure). Hygromas can also form outside of pre-existing cavities, for example, among masses of absorbing exudate or hemorrhages (h. durae matris in pachymeningitis), serving as an indicator of this resorption. Sometimes a hygroma represents only a local, demarcated edema of the cellular tissue, when the fluid, pushing apart the tissue elements, forms a cyst-like accumulation among them; for example, one speaks of perirenal hygroma (h. perirenale, or perirenal hydronephrosis, see). In hygromas of non-inflammatory origin, the term "chronic dropsy" is also used instead of hygroma. The category of hygromas arising on the basis of abnormal development includes h. colli congenitum (see below). Pathological-anatomical changes are expressed at the beginning of the disease in the thickening of the walls of the tendon sheath,

whose cavity... [text gap in original OCR] ...filled with fluid of a yellow color, rich in fibrin; then a loosening of the synovial membrane occurs and its adhesion to the tendon. In most cases, rice bodies (see) - corpora oryzoidea - develop abundantly, which serves as a sign of the tuberculous nature of the disease. - The course of a hygroma is slow. Over the course of several years, a small tumor enlarges, its borders become smoothed out, pain appears, local temperature elevation occurs, perforation to the outside may happen, resulting in a non-healing fistula that secretes a thick seropurulent fluid and rice bodies. Secondary infection can lead to the development of severe phlegmon and generalized sepsis. Diagnosing a hygroma is usually not difficult. Treatment in the initial stages is conservative - rest (splinting), puncture to prevent perforation, and injection of iodoform emulsion. Recently, radiotherapy has been recommended (Wetterer). Surgical treatment consists of removing the entire affected area of the tendon sheath while leaving the tendons undamaged whenever possible. The wound is invariably sutured tightly. To avoid contractures, early movement is prescribed. Recurrences frequently occur. In severe cases of hygroma, especially in the presence of secondary infection, amputation of the limb is performed. Hygroma of synovial bursae - see also Bursitis. Literature: Garré C., Die primäre tuberkulöse Sehnenscheidenentzündung, Bruns Beiträge zur klinischen Chirurgie, B. VII, 1891; Wetterer J., Strahlenbehandlung der Tuberkulose, Strahlentherapie,

B. XI, 1920; Riese H., Die Reiskörnchen in tuberkulös erkrankten Synovialsäcken, Deutsche Zeitschrift f. Chirurgie, B. XLII, H. 1, 1895. Hygroma colli congenitum cysticum, a congenital tumor of the neck of the lymphangioma type (see), developing along the course of the lymphatic vessels (see figure). It has the appearance of a unilocular or multilocular cyst, lined with endothelium and containing either serous or milky, sometimes brownish-chocolate fluid, mixed with detritus and cholesterol; thick bundles of smooth muscle fibers are frequently found in the walls of the cysts. Besides the neck (most frequently in the submaxillary region), tumors of this kind are occasionally observed in the shoulder girdle region, the lumbosacral region, and in the mesentery, where in the latter case the cavities of the tumor are sometimes filled with chyle (chylangioma). The size and growth rate of the tumor vary; sometimes it descends fairly rapidly from the neck down to the sternum (see figure) or, rising upward, involves the lower part of the face, sometimes penetrating deep into the tissues to the spine; large hygromas can serve as an obstacle to the act of childbirth, as well as cause swallowing, respiratory, and circulatory difficulties. The formal genesis of hygroma colli congenitum cysticum is developmental abnormalities in the sense of excessive formation of lymphatic vessels in the absence of the usual fusion of these vessels with the rest of the lymphatic system. Treatment is surgical; spontaneous cure through rupture of the tumor sac occurs very rarely.