Case#5

History: Young female with history of vascular malformation in the leg and failed surgical attempts. Persistent pain and small size upper calf. 

Photo shows a surgical scar and small upper calf. No obvious skin abnormalities are seen.

• MRI (see above & below): T2 weighted axial image (above 2nd image) shows a typical venous malformation (low-flow vascular birthmark) involving the muscle groups in the back of the knee. Post-contrast MR images (above 3rd image and below 1st image) demonstrate characteristic inhomogeneous, but intense contrast enhancement. 
• Arteriogram. This study 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 (below, 2nd image) shows no arterial abnormalities. However, delayed phase (venous phase) demonstrates the malformation with scattered inhomogeneous filling of the lesion with the contrast material. 

Diagnosis: VM (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).