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Case#11:
Small -Moderate venous malformation (hemangioma) in
the elbow, History of failed surgical excision. |
Arteriogram
(Arteriography) demonstrated delayed opacification
with no arterial involvement. T2 weighted
MRI axial images through the elbow demonstrate
hyperintense (bright) lesion in the muscles extending
into the subcutaneous area. The lesion is located
around the brachial artery and major nerves which
makes surgical excision very difficult, if not
impossible (without major sequela).
Venous access is usually maintained and is used for
flushing the deep veins during the procedure so that
potential sclerosant drainage into the deep venous
system would not cause thrombosis (deep vein
thrombosis).
With adequate venous outflow control, sclerosant agent
mixed with contrast material (ethiodol) is then
injected into the malformation under careful
fluoroscopic control. |
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Case#12:
Pain in the calf, young female patient. No skin
lesion. |
TOF
MRA (actually MRV or MR venography) shows obvious
relatively large caliber vasculature in the lateral
calf demonstrating strong venous flow (directed back
to the heart). Contrast-enhanced MRA demonstrating
early opacification of the vasculature (arteries and
veins) in the diseased leg. Based on these MR
findings, arteriovenous
fistula (AVF) is suspected. AVM
is much less likely. Surgical ligation is favored over
transcatheter embolization in this case due to short
communicating arteriovenous channel. Embolization
would be a risky intervention in this case. |
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Case#13:
Congenital lesion in the thigh, noted at birth. |
Differential
should include congenital hemangioma (or rapidly
involuting congenital hemangioma - RICH) and
congenital sarcoma. Congenital sarcoma (fibrosarcoma)
is probably less common than RICH.
Biopsy of the lesion may be needed in selected cases.
Platelet count and thyroid hormone levels needs to be
checked. Imaging findings of this condition may be
quite confusing; probably this has caused unnecessary
interventions in many patients throughout the country.
If needed, transcatheter embolization is the treatment
of choice to close off some of the arterial feeders,
and surgery is required in small number of
patients. |
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Case#14:
AVM in the calf with multiple embolization
procedures.
|
Arteriogram
demonstrated a residual AVM nidus was noted below the
knee. selective contrast injections in the small
arterial feeders demonstrated AV connections (early
venous opacification is obvious). The AVM nidus was
then embolized with particles - embospheres using a
microcatheter system. Follow-up arteriogram showed no
significant residual abnormal AV connection and patent
runoff arteries. For further information on
transcatheter embolization click here.
|
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Case#15:
Spinal Hemangioma
|
Due
to unusual skin lesion (? pseudo-port-wine stain), Cobb
disease is suspected. CTA
was performed (not shown here) which did not show any
high-flow anomaly and demonstrated above detailed soft
tissue abnormality. This abnormality showed
inhomogenous subtle contrast enhancement. Based
on these findings, low-dose radiotherapy is
recommended for her pain. CT imaging after therapy to
decide the degree of involvement of the vertebral
bodies. If the vertebral bodies appear weak at that
point (prone to compression fracture), vertebroplasty
will be considered to lower the risk of vertebral
collapse (which would cause acute cord compression in
this patient). Diagnosis: Spinal (vertebra)
venous malformation ("hemangioma") with
extraosseous soft tissue component. |
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Case#16:
Forearm venous malformation causing significant pain.
|
T1W
axial image through the proximal forearm
(near the elbow) shows a heterogeneous mass-like
lesion involving the muscle groups. The bright portion
of the lesion represents fatty tissue, and gray
color portion represent a vascular portion of the malformation.
Fat-suppressed T1W image following intravenous
contrast injection demonstrates a typical contrast
enhancement pattern in association with suppression of
the fatty signal. This is a nice example to
demonstrate the fact that significant number vascular
anomalies demonstrates increased fatty tissue. A
radiographic image (during sclerotherapy) outlines the
lesion with rounded filling defects representing
phleboliths. Management in these patients does not
differ from other low-flow venous or lymphatic
lesions. This patient was successfully treated with sclerotherapy. |
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Case#17:
Hemangioma overlying the lumbosacral spine
|
8
year old girl, born with a hemangioma at the base of
her spine; described as "it is only on the surface and doesn't
effect her nervous system. The docs did the
"wait and see" and after 8 years, the
redness is all but gone. The "swell" seems
to be getting larger. Is this a secondary
abnormality (fibrofatty tissue) or something else,
like a tumor? No one seems to know anything here
about these vascular birthmarks". MRI was performed
to evaluate the underlying spinal structures and
lipomyelomeningocele diagnosis was made.
|
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Case#18:
Forehead infantile hemangioma in a 9 weeks old
babygirl
|
9
week old girl with a red somewhat raised lesion on her
forehead. First
noticed at birth by the Paediatrician. At that stage it
was just a faint mark. By 4 weeks the lesion was
starting to bubble and go dark red. It has continued to
grow since and is now flatter in appearance along with
dark blackish spots. There is normal skin around the
lesion that is also raised...
|
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Case#19:
Swelling in the neck
|
"diagnosed
with cystic hygroma at the age of 2 months after a knot
came up on the left side of his neck...
referred to a surgeon. Observation is suggested.
it
went down significantly in a month..
At
about 1 year, another mass came up in the same site.
It was determined
that it was a swollen lymph node and not a recurrence of
the
cystic
hygroma.. more
|
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Case#20: Liver hemangioma
was diagnosed incidentally
|
Ultrasound (US)
examination of a 55 year old patient with some abdominal
discomfort showed a small lesion in the liver. The
appearance of the lesion was suggestive of benign
hepatic cavernous hemangioma (venous
malformation), but not characteristic. The patient
was significantly concerned for a possibility of hepatic
metastatic disease due to past medical history of colon
carcinoma (surgically removed several years ago with no
known metastases). Therefore, further imaging was
performed.
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