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Case#1: Upper
Lip lesion, was born with this lesion, soft, not painful
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Diagnosis:
Capillary
Venous Malformation. Although
this malformation was initially considered a venous malformation
based on history, clinical presentation and MRI,
arteriography showed that the malformation has
multiple tiny feeding arteries with multiple draining
veins resulting in relatively rapid arteriovenous
shunt (similar to AVMs). The final diagnosis was
capillary venous malformation (CVM). Treatment:
This lesion was embolized two times with poor
response. The lesion was subsequently removed
surgically. For more details, click here. |
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Case#2:
Pulsatile
lesion on the outer side of the foot, painful, first
noted several years ago
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Imaging
Studies: T2 weighted
MRI image shows some abnormal
signal around the 5th metatarsal bone, inconclusive;
Gradient echo image shows a few bright
signals in the area, suggestive a high-flow lesion
(AVM); Arteriogram revealed an AVM lesion, arterial feeders
are from the anterior tibial artery; Diagnosis:
AVM
(Arteriovenous Malformation); Treatment:
Transcatheter
embolization. No complication. For more
details, click here. |
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Case#3: Pain
and swelling in the upper calf area in a young female.
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MRI findings suggested an AVM lesion.;
Diagnosis: AVM;
Treatment:
Transcatheter
embolization. Images show an AVM lesion in the upper calf with intense
contrast enhancement of the AVM nidus. This is a
high-flow vascular anomaly (vascular birthmark)
draining into the deep venous system. There are
multiple small arterial feeders seen; Selective catheterization of one of
the arterial feeders and selective arteriograms show
rapid arteriovenous blood flow and tortuous
vasculature in the nidus area. This vascular bed was
subsequently embolized with absolute alcohol; Direct percutaneous puncture of the
varicoid aneurysmal venous lesion and contrast
injection and coil embolization of the venous
abnormality; on post-embo image the lesion is no longer fills with contrast and
the extremity arteries are widely patent. For
more info, click here. |
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Case#4: Pain
and small bluish skin discoloration in the elbow region.
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Imaging
Studies: T2 weighted axial
MRI image
shows a typical venous malformation (low-flow vascular
birthmark) located superficially just under the skin.
The underlying muscle groups appear normal. Direct
contrast injection into the malformation outlines the small venous anomaly and also
demonstrates venous drainage pathways of the lesion.
Diagnosis:
Venous
Malformation;
Treatment:
This lesion can be treated surgically or by
percutaneous means (Sclerotherapy).
Sclerotherapy was selected in this case and a tiny
amount of sclerosant agent was used. Good results and no
complication. For more info, click here. |
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Case#5:
Painful calf / knee without obvious skin abnormalities.
Failed surgical excision history.
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Imaging
Studies: MRI T2 weighted axial image shows a typical venous
malformation (low-flow vascular birthmark) involving
the muscle groups in the back of the knee.
Post-contrast MR images demonstrate characteristic
inhomogeneous, but intense contrast enhancement.
Arteriogram was performed at different
institution earlier. In general, arteriography is not
needed for venous malformations and these lesions can
not be treated with transcatheter embolization.
Arterial phase of the study shows no arterial
abnormalities. However, delayed phase (venous phase)
demonstrates the malformation with scattered
inhomogeneous filling of the lesion with the contrast
material. Diagnosis:
Venus
Malformation (failed surgical excision);
Treatment:
This lesion can not be treated surgically due to
the fact that the muscles are involved with this
malformation extensively. However, this lesion can be
treated with percutaneous means (Sclerotherapy).
Click here
for more info. |
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Case#6: Superficial
skin lesion in the upper extremity. Gradually growing,
but not painful.
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Imaging
Studies:
No imaging studies were performed. MRI is the ideal
imaging modality if diagnostic work-up is indicated.
ultrasonography is commonly performed for these
patients, but it is unnecessary in many patients and
also may cause diagnostic dilemma if a sonographer is
not familiar with these malformations. Also, CT or
plain radiography have limited value in the diagnostic
work-up and are not indicated. Diagnosis:
Infantile
Hemangioma; Treatment:
Treatment is not needed. Please click here
to see therapeutic strategies for hemangiomas. Click here
for more info about this case. |
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Case#7: Focal
neck enlargement in an infant.
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MRI
T2 weighted coronal images show a typical mixed form
(macrocystic and microcystic) lymphatic malformation
(low-flow vascular birthmark). These lesions are
commonly called cystic hygroma. Please note that there
is signal abnormalities in the lower section of the
tongue. Tongue involvement is relatively common in
lymphatic malformations of the head and neck.
These low-flow malformations do not demonstrate
contrast enhancement on post-contrast scans (not
shown). Diagnosis:
Lymphatic
Malformation (Cystic Hygroma); Treatment:
This lesion can not be excised completely
(surgically). In this patient, most appropriate
therapeutic approach would be direct percutaneous
sclerosant injection (sclerotherapy).
Click here
for more information about this case. |
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Case#8:
Small painful skin lesion and painful calf in a young
boy.
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There is a small vascular lesion with a
few tiny arterial feeding arteries from the peroneal
artery (arteriography). There is not obvious rapid filling of the
veins to suggest arteriovenous malformation. However,
in early phases of AVM, this may be seen. This is more
suggestive of a benign intramuscular
hemangioma tumor. Selective injection
of the arterial feeder outlining the lesion with a
relatively rapid filling of the regional draining
veins. This lesion was treated with transcatheter
embolization using small particles.
Port-embolization arteriography shows no residual
lesion after the embolization. Click here
for more information. |
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Case#9:
Painful right hip and pulsatile soft tissue swelling in
a young female. |
X-ray:
Increased trabeculation and a cystic bone lesion in
the proximal femur. MRI: T1 weighted image shows
flow related signal loss (dark signal) in the area,
suggestive of a high-flow malformation (vascular
birthmark). Conventional
Arteriogram (Angiography) (3rd and 4th images):
Obvious increased vascularity is seen in the area with
an aneurysmal venous abnormality and large draining
veins. Diagnosis: AVM.
Discussion: Arteriovenous malformations are high-flow
vascular birthmarks and commonly involve the soft
tissues, and in some cases, they may involve the
bones. Bone changes related to AVM are not well
documented in the literature. This case clearly
demonstrates possible bony changes due to high-flow
nature of these anomalies. Currently, it is unclear if
these bone changes may cause significant weakening. |
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Case#10:
Small soft tissue swelling in the thumb. |
Diagnosis:
Infantile
hemangioma. MRI is limited in this case; because
the area of interest (hand / thumb) is a small body
part and the lesion is also small in size. In most
larger infantile hemangiomas, MRI can be more helpful
in terms of confirming the suspected diagnosis and
also to outline the margins of the malformation. Most
large infantile hemangiomas demonstrates relatively
homogeneous contrast enhancement and some small
fast-flow vascularity in the periphery of the mass, as
well as in the surrounding soft tissues. Overall, rare
possibilities (e.g., malignancy) can not be entirely
excluded in this case based on this MR scan. Final
decision should be made based on clinical history and
assessment. |
