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Case#12 History:
Young female with history of calf pain. No skin
lesion. No size difference between the calves.
Clinically AVM (arteriovenous malformation) is
suspected.
Imaging Studies:
- MRI / MRA:
Time-of-Flight (TOF) and contrast enhanced MR
angiography (MRA) was performed (See the images
below).
1st
image is TOF MRA (actually MRV or MR venography).
There is an obvious relatively large caliber
vasculature seen in the lateral calf demonstrating
strong venous flow (directed back to the heart). 2nd
and 3rd images are 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.
1st and 2nd DSA images show enlargement of
the arterial system in the diseased leg, which is secondary
to arteriovenous shunting. 3rd and 4th images demonstrate
direct arteriovenous communication (AVF) with early filling
of the normal appearing deep veins. The communication
channel is very short or just a fenestration.
Diagnosis:
AVF
(Arteriovenous Fistula)
Treatment
/ Discussion:
This lesion should be treated surgically rather
than transcatheter means. Transcatheter embolization
would be technically challenging due to short
arteriovenous communication. Surgical ligation of
the arterio-venous fistula is recommended in this case.
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