Case#2

History: A male child with an upper lip soft vascular malformation, not pulsatile or painful.

Imaging Studies:

  • Photo (1st image)
  • MRI - T2 weighted image (2nd image): bright lesion, sharp margins, consistent with VM
  • MRI- Post contrast image (3rd image): Intense contrast enhancement, consistent with VM
  • CTA (4th image) - A vascular lesion with a good size draining vein into the facial vein (arterial involvement unclear)
  • Arteriogram -arterial phase (5th image): Tiny arterial feeders are seen from the facial artery
  • Arteriogram - venous phase (last image): Several draining veins are seen.

              

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.

 
   

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