William Eugene Shiels DO, Presenter: President, Mauka Medical Corporation Owner, Mauka Medical Corporation Patent holder, Shiels Intussusception Air Reduction Device

Carly M. Dent BS, Abstract Co-Author: Nothing to Disclose

James Walter Murakami MD, Abstract Co-Author: Nothing to Disclose

To evaluate clinical feasibility and efficacy of percutaneous ultrasound guided treatment of microcystic lymphatic malformations with doxycycline microfoam.

Sixty patients with microcystic lymphatic malformations (MiLM) (≤1cm), ages 2 month-60yr were treated with ultrasound guided aspiration and injection of doxycycline microfoam (doxyfoam) (5mg/ml). Treatment was a component of a staged treatment plan for macrocystic and/or microcystic lymphatic malformations in the scalp, face, orbit, neck, trunk, abdomen, scrotum, and extremities. Injections were performed with 25-21G needles. Feasibility evaluation included ability to perform aspiration and injection through a single needle, echogenicity of Doxyfoam, patterns of drug delivery, pitfalls, and complications.

Sixty patients successfully underwent 123 MiLM treatments (mean=2.4 treatments/pt), treating 1250 microcysts. Patient follow-up ranges from 2-48 months (mean=16 months). Mean number of microcysts treated per session =13, mean dose Doxycycline per session= 77 mg (range 2-740 mg). Complete elimination of discernible microcysts following 1 treatment was documented in 23/60 (38%) patients. Patterns of drug delivery included doxyfoam isolated to individual microcysts of treatments and flow of doxyfoam into communicating microcystic tributaries in solid LM components. Doxyfoam was echogenic in 123/123 (100%) of treatments. Cysts >1 mm were successfully aspirated 113/123 (92%), with cysts ≤ 1mm collapsed with puncture without aspiration. Pitfalls include streaming of doxyfoam with needle removal and doxyfoam obscuration of underlying cysts during early superficial injection. No complications occurred, to include no nerve injury, hair loss, or skin burns (unintentional).

Doxycycline microfoam is feasible, safe, and effective for percutaneous treatment of MiLM in a broad range of anatomic locations.

This US guided Doxycycline microfoam regimen provides a safe, effective, and predictable percutaneous treatment of MiLM in a broad range of anatomic locations.

Shiels, W, Dent, C, Murakami, J, Percutaneous Treatment of Microcystic Lymphatic Malformation.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9010553.html