# Lymphatic Malformation — GCMD Library living collection

Everything in the library about lymphatic malformation — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 69 cited statements

## Episodes
### Case-Based Learning
- [Update Course Rewind 2025: Neck Pathologies - The Diagnostic Challenge](https://library.globalcastmd.com/watch/update-course-rewind-2025-neck-pathologies-the-diagnostic-challenge-13880) — video · 3:55 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-2025-neck-pathologies-the-diagnostic-challenge-13880.md)

### In-Depth Reviews
- [Lymphatic Anomalies](https://library.globalcastmd.com/watch/lymphatic-anomalies-361) — podcast · 43:16 · [machine version](https://library.globalcastmd.com/watch/lymphatic-anomalies-361.md)
- [Lymphatic Anomalies](https://library.globalcastmd.com/watch/lymphatic-anomalies-290) — podcast · 43:16 · [machine version](https://library.globalcastmd.com/watch/lymphatic-anomalies-290.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=0) Introduction and Classification Overview (Ep 2)
- [2:02](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=122) ISSVA Classification System (Ep 2)
- [4:20](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=260) Clinical Importance of Proper Classification (Ep 2)
- [6:33](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=393) Case Presentation and Interdisciplinary Approach (Ep 2)
- [8:51](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=531) Role of Surgery and Treatment Selection (Ep 2)
- [13:23](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=803) Medical Therapy with mTOR Inhibitors (Ep 2)
- [18:29](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1109) Combining Medical and Surgical Therapy (Ep 2)
- [21:30](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1290) Observation as a Treatment Option (Ep 2)
- [27:35](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1655) Diagnostic Workup and Burroughs Rule (Ep 2)
- [31:45](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1905) Sclerotherapy Techniques and Safety (Ep 2)
- [35:45](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=2145) Global Practice Patterns and Complex Cases (Ep 2)
- [40:34](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=2434) Resources and Summary (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=0) Introduction and Classification Overview (Ep 1)
- [2:12](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=132) ISSVA Classification and Nomenclature (Ep 1)
- [6:32](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=392) Case Discussion: Truncal Macrocystic Lesion (Ep 1)
- [13:32](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=812) Role of Medical Therapy (mTOR Inhibitors) (Ep 1)
- [21:30](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=1290) Observation, Natural History, and Follow-Up (Ep 1)
- [28:28](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=1708) Diagnostic Workup and Sclerotherapy Technique (Ep 1)
- [35:45](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=2145) Global Practice Patterns and Referral Resources (Ep 1)
- [42:58](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=2578) Closing Remarks (Ep 1)
- [0:08](https://library.globalcastmd.com/watch/update-course-rewind-2025-neck-pathologies-the-diagnostic-challenge-13880?t=8) Case Presentation: 16-Year-Old with Submandibular Swelling (Ep 3)
- [1:03](https://library.globalcastmd.com/watch/update-course-rewind-2025-neck-pathologies-the-diagnostic-challenge-13880?t=63) Diagnostic Journey and Recurrent Interventions (Ep 3)
- [2:10](https://library.globalcastmd.com/watch/update-course-rewind-2025-neck-pathologies-the-diagnostic-challenge-13880?t=130) Treatment Approaches for Ranula (Ep 3)
- [2:43](https://library.globalcastmd.com/watch/update-course-rewind-2025-neck-pathologies-the-diagnostic-challenge-13880?t=163) Lymphatic Malformation Treatment Options (Ep 3)
- [3:11](https://library.globalcastmd.com/watch/update-course-rewind-2025-neck-pathologies-the-diagnostic-challenge-13880?t=191) Key Takeaways and Differential Diagnosis Framework (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "A ranula is a benign cyst that forms under the tongue caused by saliva leaking from a blocked sublingual gland." — Jill Knepprath (host_summary) [Ep 3 · 0:50](https://library.globalcastmd.com/watch/update-course-rewind-2025-neck-pathologies-the-diagnostic-challenge-13880?t=50)
- "Lymphatic malformations are clusters of lymph vessels that are often present at birth." — Jill Knepprath (host_summary) [Ep 3 · 0:58](https://library.globalcastmd.com/watch/update-course-rewind-2025-neck-pathologies-the-diagnostic-challenge-13880?t=58)
- "It can be really hard to differentiate a giant ranula from a lymphatic malformation." — Doug Van Alman (clinical) [Ep 3 · 1:14](https://library.globalcastmd.com/watch/update-course-rewind-2025-neck-pathologies-the-diagnostic-challenge-13880?t=74)
- "The lab tends to have trouble running thick fluid from aspirated neck masses." — Doug Van Alman (clinical) [Ep 3 · 1:24](https://library.globalcastmd.com/watch/update-course-rewind-2025-neck-pathologies-the-diagnostic-challenge-13880?t=84)
- "Lymphatic malformations near glandular tissue can have leaching of saliva into them, resulting in false positive amylase testing." — Doug Van Alman (clinical) [Ep 3 · 1:28](https://library.globalcastmd.com/watch/update-course-rewind-2025-neck-pathologies-the-diagnostic-challenge-13880?t=88)
- "Removal of the sublingual gland has been the best practice for ranula treatment." — Doug Van Alman (guideline) [Ep 3 · 2:10](https://library.globalcastmd.com/watch/update-course-rewind-2025-neck-pathologies-the-diagnostic-challenge-13880?t=130)
- "When a ranula has a cervical component, you can aspirate that and as long as you remove the sublingual gland, it should go away." — Doug Van Alman (clinical) [Ep 3 · 2:16](https://library.globalcastmd.com/watch/update-course-rewind-2025-neck-pathologies-the-diagnostic-challenge-13880?t=136)
- "Micromarsupialization is a new technique for treating ranula with an intraoral component, involving placement of silk sutures through the cyst for 30 days to develop a fistula that spontaneously drains into the mouth." — Doug Van Alman (clinical) [Ep 3 · 2:25](https://library.globalcastmd.com/watch/update-course-rewind-2025-neck-pathologies-the-diagnostic-challenge-13880?t=145)
- "For lymphatic malformations, there are 3 procedural treatments: laser, sclerotherapy, and excision." — Jill Knepprath (host_summary) [Ep 3 · 2:43](https://library.globalcastmd.com/watch/update-course-rewind-2025-neck-pathologies-the-diagnostic-challenge-13880?t=163)
- "There are 3 medical therapies for lymphatic malformations that are still undergoing clinical trials." — Jill Knepprath (host_summary) [Ep 3 · 2:49](https://library.globalcastmd.com/watch/update-course-rewind-2025-neck-pathologies-the-diagnostic-challenge-13880?t=169)
- "Gene panels now guide medical therapy for lymphatic malformations, particularly PIK3CA mutations which suggest that alpelisib (a PI3K alpha inhibitor) can be useful." — Doug Van Alman (clinical) [Ep 3 · 2:53](https://library.globalcastmd.com/watch/update-course-rewind-2025-neck-pathologies-the-diagnostic-challenge-13880?t=173)
- "For congenital developmental neck masses, you have to deal with the embryological component and etiology to prevent recurrence, not just excise the mass." — Doug Van Alman (clinical) [Ep 3 · 3:15](https://library.globalcastmd.com/watch/update-course-rewind-2025-neck-pathologies-the-diagnostic-challenge-13880?t=195)
- "The ISSVA classification system was updated in 2014 and is based on John Mulligan's original classification from Boston Children's Hospital" — Denise Adams (guideline) [Ep 2 · 2:12](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=132)
- "Lymphatic anomalies are classified into lymphatic tumors and lymphatic malformations, with malformations further divided into macrocystic, microcystic, combined lesions, generalized lymphatic anomaly, Gorham-Stout disease, and central conducting anomalies" — Denise Adams (clinical) [Ep 2 · 2:58](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=178)
- "Using incorrect terminology like cystic hygroma and lymphangioma causes confusion among clinicians, colleagues, and patients" — Steve Fishman (opinion) [Ep 2 · 4:45](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=285)
- "Macrocystic lymphatic malformations can be described to patients as like a bunch of grapes where each grape is visible and can be accessed with a needle for sclerotherapy" — Steve Fishman (clinical) [Ep 2 · 5:43](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=343)
- "Microcystic lesions are like a small porous sponge with cysts too tiny to see individually, making sclerotherapy less practical" — Steve Fishman (clinical) [Ep 2 · 6:14](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=374)
- "Most lymphatic malformations are present at birth and visible at birth, though some may present later with sudden expansion" — Steve Fishman (clinical) [Ep 2 · 9:06](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=546)
- "There are four general treatment options for lymphatic malformations: observation with reassurance, microinterventional therapy with needle or catheter, resective surgery, and pharmacological therapy" — Steve Fishman (clinical) [Ep 2 · 10:05](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=605)
- "For very large truncal lesions extending from axilla to pelvis, surgical resection may be preferred over multiple sclerotherapy sessions to avoid significant radiation exposure and potentially unsatisfactory outcomes from residual tissue" — Steve Fishman (opinion) [Ep 2 · 12:30](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=750)
- "Sirolimus (rapamycin) is an mTOR inhibitor that blocks the PIK3CA pathway, which has been shown to be a somatic mutation in many lymphatic malformations" — Denise Adams (clinical) [Ep 2 · 15:43](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=943)
- "Boston Children's Hospital received FDA funding in 2008 to study sirolimus for complicated vascular anomalies based on the hypothesis that the PIK3CA pathway controls blood vessel growth" — Denise Adams (clinical) [Ep 2 · 16:18](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=978)
- "Sirolimus improved quality of life, decreased pain, and reduced infection frequency in patients with complicated lymphatic anomalies" — Denise Adams (clinical) [Ep 2 · 16:59](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1019)
- "Preoperative sirolimus therapy can soften lymphatic tissue and decrease lesion size, making surgical procedures less extensive" — Denise Adams (clinical) [Ep 2 · 17:41](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1061)
- "Operating on patients while continuing sirolimus makes tissue softer, allows easier elevation of skin flaps, and enables more extensive resection with better closure compared to operating without the medication" — Steve Fishman (clinical) [Ep 2 · 19:31](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1171)
- "Sirolimus is unlikely to be useful for purely macrocystic lesions, and the tissue expansion effect from large cysts can actually make surgery easier" — Steve Fishman (opinion) [Ep 2 · 20:25](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1225)
- "Spontaneous resolution of macrocystic lymphatic malformations occurs in less than a handful of cases out of several thousand patients" — Steve Fishman (epidemiological) [Ep 2 · 22:33](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1353)
- "EXIT procedures are not really necessary for lymphatic lesions because they are soft and compressible, allowing intubation, unlike firm teratomas" — Steve Fishman (clinical) [Ep 2 · 23:27](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1407)
- "Babies with congenital lymphedema of the lower extremities can have regression to the point of non-detection on physical exam, though this is uncommon" — Steve Fishman (clinical) [Ep 2 · 25:11](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1511)
- "For lesions impinging on the airway that could cause emergency if infected or bleeding occurs, observation is not a good option" — Steve Fishman (clinical) [Ep 2 · 25:55](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1555)
- "Early treatment in infancy is now preferred for microcystic lesions on the face, tongue, and floor of mouth, with medical therapy rather than surgery" — Steve Fishman (opinion) [Ep 2 · 26:09](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1569)
- "Burroughs rule states that if diagnosis is not classic on history, physical, and imaging, tissue biopsy is necessary" — Steve Fishman (guideline) [Ep 2 · 29:28](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1768)
- "Doxycycline is used for macrocystic lesions, bleomycin for microcystic lesions (with monitoring for side effects), and sodium tetradecyl sulfate for venous components" — Belinda Dickey (clinical) [Ep 2 · 33:10](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1990)
- "A small amount of ethanol systemically can cause sudden fatal pulmonary hypertension" — Steve Fishman (clinical) [Ep 2 · 34:25](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=2065)
- "Large venous anomalies with direct macroscopic outflow to systemic veins can result in pulmonary embolism from clot induced by sclerotherapy" — Steve Fishman (clinical) [Ep 2 · 34:45](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=2085)
- "Venous mapping by MR, ultrasound, or venography is essential before sclerotherapy, and direct venous outflow must be obliterated first using laser, coils, or glue to prevent fatal pulmonary embolism" — Steve Fishman (clinical) [Ep 2 · 34:59](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=2099)
- "Most sclerotherapy worldwide is likely performed by surgeons rather than interventional radiologists because many countries lack image-guided fluoroscopy suites" — Steve Fishman (epidemiological) [Ep 2 · 37:12](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=2232)
- "When bleomycin was first used for vascular anomalies, there were reported cases of pneumonitis because practitioners didn't understand there is a maximum safe dose" — Denise Adams (clinical) [Ep 2 · 38:09](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=2289)
- "Patients with central conducting lymphatic anomalies can present with subcutaneous chyle, eroding bones, chylous ascites, chylothorax, and chyle dripping from urethra, scrotum, vagina, or even from under toenails" — Steve Fishman (clinical) [Ep 2 · 39:38](https://library.globalcastmd.com/watch/lymphatic-anomalies-290?t=2378)
- "The ISSVA (International Society for the Study of Vascular Anomalies) classification system, updated in 2014, divides lymphatic anomalies into lymphatic tumors and lymphatic malformations, with malformations further categorized as macrocystic, microcystic, combined, generalized lymphatic anomaly, Gorham-Stout disease, or central conducting anomalies." — Denise Adams (guideline) [Ep 1 · 2:12](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=132)
- "The terms 'cystic hygroma' and 'lymphangioma' are outdated and should not be used; the correct term is 'lymphatic malformation' because it describes malformed embryologic lymphatic tissue." — Steve Fishman (guideline) [Ep 1 · 4:29](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=269)
- "Macrocystic lymphatic malformations have cysts large enough to be individually visualized (like a bunch of grapes), making them amenable to needle aspiration and sclerotherapy." — Steve Fishman (clinical) [Ep 1 · 4:29](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=269)
- "Microcystic lymphatic malformations have cysts too small to see individually, presenting as a soft tissue mass like a porous sponge, making sclerotherapy less practical." — Steve Fishman (clinical) [Ep 1 · 4:29](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=269)
- "Most lymphatic malformations are present at birth and visible at birth, though some may present later (e.g., at age 2) with sudden expansion of a previously undetected lesion." — Steve Fishman (clinical) [Ep 1 · 8:51](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=531)
- "Differential diagnosis for a 2-year-old with a new mass includes sarcomas, teratomas, and infectious lesions, not just lymphatic malformations." — Steve Fishman (clinical) [Ep 1 · 8:51](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=531)
- "Four general treatment options for lymphatic malformations are: observation/reassurance, microinterventional therapy (sclerotherapy), resective surgery, and pharmacological therapy." — Steve Fishman (clinical) [Ep 1 · 8:51](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=531)
- "For localized macrocystic lesions, sclerotherapy is preferred if one or two sessions can achieve a durable result without leaving a concerning scar; for very small lesions, minor resection may be preferred for a more durable outcome." — Steve Fishman (opinion) [Ep 1 · 8:51](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=531)
- "Very large macrocystic lesions extending from axilla to pelvis may warrant upfront surgical resection rather than multiple sclerotherapy sessions, because shrinking all cysts still leaves redundant skin and septa that may require eventual resection anyway." — Steve Fishman (opinion) [Ep 1 · 8:51](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=531)
- "Sirolimus (rapamycin) and everolimus are mTOR inhibitors that block the PIK3CA pathway, which is implicated in somatic mutations found in many lymphatic malformations." — Denise Adams (clinical) [Ep 1 · 14:23](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=863)
- "A 2008 FDA-funded study at Boston Children's Hospital demonstrated that sirolimus improved quality of life, reduced pain, and decreased infection frequency in patients with complicated vascular anomalies with a lymphatic component." — Denise Adams (clinical) [Ep 1 · 14:23](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=863)
- "Preoperative mTOR inhibitor therapy can soften lymphatic tissue, decrease lesion size, and make surgical debulking less extensive." — Denise Adams (clinical) [Ep 1 · 14:23](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=863)
- "Dr. Fishman routinely operates on complex lesions (e.g., Klippel-Trénaunay syndrome) without stopping sirolimus preoperatively, finding that the tissue is softer and skin flaps more pliable, allowing more extensive resection with better closure." — Steve Fishman (opinion) [Ep 1 · 18:29](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=1109)
- "Purely macrocystic lesions are unlikely to benefit from sirolimus therapy; the drug is more useful for microcystic and complex lesions." — Steve Fishman (opinion) [Ep 1 · 18:29](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=1109)
- "Most lymphatic malformations do not spontaneously resolve, though rare cases of macrocystic lesions have deflated and remained quiescent for over a decade." — Steve Fishman (clinical) [Ep 1 · 22:04](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=1324)
- "Dr. Fishman observed a massive cervical and mediastinal macrocystic lymphatic malformation detected prenatally that became undetectable on physical exam within less than a year after birth, without intervention." — Steve Fishman (clinical) [Ep 1 · 22:04](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=1324)
- "Babies with congenital lymphedema of the lower extremities can have regression to the point of non-detection on physical exam, though this is uncommon." — Steve Fishman (clinical) [Ep 1 · 22:04](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=1324)
- "For lesions not impinging on the airway or causing functional impairment, observation is a safe option, and the choice to intervene can be deferred." — Steve Fishman (opinion) [Ep 1 · 22:04](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=1324)
- "Lesions impinging on the airway that could cause an emergency if infected or if they bleed internally should not be observed; early intervention is indicated." — Steve Fishman (opinion) [Ep 1 · 22:04](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=1324)
- "Microcystic lesions on the face, tongue, or floor of the mouth are now treated very early in infancy, as early treatment likely yields better long-term results than delayed treatment." — Steve Fishman (opinion) [Ep 1 · 22:04](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=1324)
- "Follow-up intervals for observed lymphatic malformations should be individualized: monthly initially for new parents, then extending to 3, 6, or 12 months as appropriate." — Steve Fishman (opinion) [Ep 1 · 26:46](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=1606)
- "Ultrasound with Doppler is the first-line imaging modality for suspected lymphatic malformations, as it is least invasive and does not require sedation or anesthesia." — Steve Fishman (clinical) [Ep 1 · 28:53](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=1733)
- "MRI is the next step if ultrasound is inconclusive." — Steve Fishman (clinical) [Ep 1 · 28:53](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=1733)
- "'Burrows' rule' (named after interventional radiologist Pat Burrows) states that if a lesion is not classic on history, physical, and imaging, tissue biopsy is necessary to confirm diagnosis." — Steve Fishman (guideline) [Ep 1 · 28:53](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=1733)
- "Dr. Fishman encountered a small leg lesion thought to be a vascular malformation that was ultimately diagnosed as synovial sarcoma on frozen section during resection; the tumor was metastatic and the patient did poorly." — Steve Fishman (clinical) [Ep 1 · 28:53](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=1733)
- "Dr. Fishman was involved in a case of a newborn with what was thought to be multifocal hemangioma of the liver, which turned out to be metastatic neuroblastoma." — Steve Fishman (clinical) [Ep 1 · 28:53](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=1733)
- "Sclerotherapy agents are chosen based on lesion type: doxycycline for macrocysts, bleomycin for microcysts (with monitoring for side effects), and sodium tetradecyl sulfate (STS) for venous components." — Denise Adams (clinical) [Ep 1 · 32:45](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=1965)
- "Venous sclerotherapy should almost always be performed under fluoroscopy to map venous drainage and prevent intravascular injection of sclerosant." — Steve Fishman (clinical) [Ep 1 · 33:56](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=2036)
- "A small amount of ethanol injected systemically during venous sclerotherapy can cause sudden fatal pulmonary hypertension." — Steve Fishman (clinical) [Ep 1 · 33:56](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=2036)
- "Large venous anomalies (e.g., in Klippel-Trénaunay syndrome) with direct macroscopic outflow to systemic veins can result in pulmonary embolism from clot induced by sclerotherapy; the outflow must be obliterated first using intravenous laser, titanium coils, glue, or guide wires." — Steve Fishman (clinical) [Ep 1 · 33:56](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=2036)
- "Bleomycin is a cancer medicine that can cause pneumonitis if maximum dose limits are not observed during sclerotherapy." — Denise Adams (clinical) [Ep 1 · 37:40](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=2260)
- "EXIT (ex utero intrapartum treatment) procedures are not really necessary for lymphatic lesions, as they are soft and compressible and intubation is always achievable, unlike firm teratomas where EXIT plays a role." — Steve Fishman (opinion) [Ep 1 · 8:51](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=531)
- "Central conducting lymphatic anomalies can present with subcutaneous chyle, eroding bones, chylous ascites, chylothorax, and chyle dripping from the urethra, scrotum, vagina, or even from under toenails." — Steve Fishman (clinical) [Ep 1 · 38:23](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=2303)
- "Combined overgrowth syndromes like Klippel-Trénaunay and CLOVES syndrome involve multi-system and multi-tissue involvement and do not have simple treatment answers; these patients benefit from expert consultation." — Steve Fishman (opinion) [Ep 1 · 38:23](https://library.globalcastmd.com/watch/lymphatic-anomalies-361?t=2303)

## Changelog
- Sep 15: 3 items added automatically

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