Case Studies #3                                             Case Studies #1           Case Studies #2

Click Case# (or image) for more information / diagnostic work-up & treatment
Case#21: Large mass like lesion the thigh An infant presented with a large soft tissue mass-like lesion in the thigh. Reportedly the previous surgical excision of the lesion had revealed histopathological diagnosis of kaposiform hemangioendothelioma. Steroid treatment was initiated; however, the patient returned with clinical signs of hemorrhage. Diagnostic work up revealed severe degree low platelets, consistent with Kasabach Merritt syndrome. Despite aggressive medical therapy, the patient required angiographic assessment, then transcatheter embolization. The patient recovered completely. Kaposiform hemangioendothelioma is associated with Kasabach Merritt syndrome in some patients and may require aggressive therapy. Although a surgical intervention is needed in some patient, some benefit significantly from transcatheter embolization. It is important to follow these patients closely for potential bleeding complications. 
Case#22: Macrocystic cervical lymphatic malformation ("cystic hygroma" patient with a progressive enlargement in the submandibular area, slightly right of the midline. The lesion reportedly becomes more prominent occasionally and barely noticeable in some days. The patient described some discomfort in the area. Physical examination revealed a soft tissue prominence in the area, soft to palpation, not sensitive to touch, easily compressible. No thrill is noted over the lesion to suggest a high flow anomaly. There are no skin changes over or near the lesion.  MRI examination (not shown here) revealed a large cyst like signal abnormality in the area. The clinical findings, history and imaging findings all consistent with a macrocystic lymphatic malformation (commonly called "cystic hygroma"). 
Case#23: Mediastinal - Chest AVM 34 year old woman presented with significant chest pain over the sternal area and shortness of breath. Previous diagnostic work-up including Doppler studies and noninvasive arteriograms - CTA (not shown here) revealed an arteriovenous malformation in the retrosternal area. The patient stated that she had this chest pain for the last several years, changing in intensity and did not respond well to pain meds. A decision was made to proceed with conventional arteriogram with possible transcatheter embolization if feasible.


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