Imaging features of an intraosseous arteriovenous malformation in the tibia

Wang, Hong-Hau; Yeh, Tsu-Te; Lin, Yu‐Chun; Huang, Guo-Shu

doi:10.11622/smedj.2015028

Cited by 7 publications

(9 citation statements)

References 16 publications

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“…MRI is an extremely important modality for assessing vascular tumors and malformations, and the presence of signal void is a hallmark MRI finding in AVMs (15–17). In previous reports (7–14), intramedullary lesions exclusively displayed a hypointense or isointense signal on T1-weighted images and a hyperintense signal on T2-weighted images, without signal voids. However, in the present case, MRI demonstrated intramedullary signal voids and feeding arteries, indicating a high-flow malformation.…”

Section: Discussionmentioning

confidence: 78%

“…Pure intraosseous AVMs that do not involve soft tissue are extremely rare (3,4). Although several intraosseous AVMs have been described in the spine or long bones (7–14), little is known on the diagnostic and therapeutic strategies for pure intraosseous AVMs. It is crucial for physicians, particularly orthopedic oncologists, to understand the clinical characteristics of pure intraosseous AVMs in order to distinguish them from primary or metastatic bone tumors.…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis and conservative treatment of a rare case of femoral intraosseous arteriovenous malformation in a patient with polyostotic fibrous dysplasia: A case report

et al. 2019

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Pure intraosseous arteriovenous malformation (AVM) in a limb bone is extremely rare. Furthermore, there is currently insufficient information on the diagnostic and therapeutic strategies for pure intraosseous AVMs. We herein report a case of pure intraosseous AVM of the proximal femur occurring in a patient with polyostotic fibrous dysplasia. The patient was a 39-year-old woman who presented with pain in the right thigh. Plain radiographs and computed tomography scans revealed a medullary lytic lesion with expansion and thinning of the bone cortex in the right proximal femur, mimicking a primary bone tumor. Magnetic resonance imaging (MRI) examination revealed intramedullary signal voids and feeding arteries arising from the deep femoral artery. A non-surgical approach using embolization and denosumab achieved satisfactory results, which included complete obliteration of the AVM, increased cortical thickness of the right proximal femur, and attenuation of the high-turnover bone metabolism 1 year later. Careful review of MRI images is crucial for distinguishing between bone tumors and intraosseous AVM, which exhibit signal voids and feeding arteries, in order to avoid unnecessary interventions such as bone biopsy or surgery.

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Diagnosis and conservative treatment of a rare case of femoral intraosseous arteriovenous malformation in a patient with polyostotic fibrous dysplasia: A case report

et al. 2019

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“…Persistent pain is often the primary symptom of patients with AVMs who seek medical care. 3,4,6,9,17,[22][23][24] Our patient presented with right lower extremity pain and swelling following injury to her right ankle. Similarly, Savader et al reported 2 cases of intraosseous extremity AVMs that presented with posttraumatic pain and swelling.…”

Section: Discussionmentioning

confidence: 87%

“…9 On the other hand, 5 additional case reports described extremity pain without a preceding history of trauma. 17,22,23,25,26 While patients can exhibit a wide range of overlying skin changes including erythema, bruising, rashes, swelling, varicosities and ulceration, several cases displayed no overlying skin findings. 15,17,19,22,23,[25][26][27] Bruits and thrills are often characteristically missing due to the deep location of the malformation.…”

Section: Discussionmentioning

confidence: 99%

A Case of an Aggressive Intraosseous Arteriovenous Malformation in the Lower Extremity: Special Considerations for Diagnosis and Management

Stribling

Abu‐Ghname

Trost

et al. 2020

Vasc Endovascular Surg

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Background: Arteriovenous malformations (AVMs) are rare, congenital vascular anomalies. Intraosseous AVMS most frequently arise in the head and neck, with only a small fraction occurring in the extremities. Herein, we report the findings of a combined soft tissue and intraosseous AVM involving the lower extremity of a 13-year-old child. This case highlights the necessity of an interdisciplinary approach for the effective treatment and management of these rare vascular anomalies. Case Description: A 13-year-old female presented with a 4-year history of intermittent pain and swelling over her right lateral malleolus. The patient was evaluated with radiologic imaging revealing an AVM involving the right distal leg, ankle, and hindfoot with intraosseous involvement of the distal tibia and talus. She was then referred to Vascular and Plastic Surgery and an angiogram was performed demonstrating shunting from the anterior tibial, peroneal, and posterior tibial arteries to the AVM. Venous drainage was to the anterior tibial and greater saphenous veins. Three embolizations were performed over the course of 6 months. Following the third embolization, the patient was taken to the operating room where Plastic and Orthopedic Surgery performed total resection of the nidus and involved bone which was then grafted with injectable synthetic bone graft. Results: Successful resection of the nidus was achieved, and the patient had an uncomplicated recovery. Within 6 months postoperatively, the patient demonstrated full range of lower extremity motion and was able to participate in age appropriate gross motor activities. Radiologic evaluation 7 months postoperatively showed no evidence of nidus recurrence. Conclusion: Intraosseous involvement of AVMS is rare and presents a therapeutic challenge due to its invasive potential and high incidence of recurrence. Wide local excision with bone grafting and interdisciplinary management are paramount for complete resection.

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“…3,7,13 The most common reported location for these intraosseous vascular malformations is the facial bones; however, intraosseous AVMs have been reported in other skeletal sites, including the humerus, radius, femur, tibia, and spine. 7,16 The management of extradural intraosseous AVMs of the head and neck is challenging and can necessitate a multidisciplinary approach. Combined embolization and resection represents the "first-line" therapy for many AVMs.…”

mentioning

confidence: 99%

The rare case of a large complex intraosseous cranial arteriovenous malformation with successful multidisciplinary management

Al-Smadi¹,

Shokuhfar²,

Johnston³

et al. 2017

Journal of Neurosurgery: Pediatrics

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Intraosseous cranial arteriovenous malformations (AVMs) are very rare, challenging entities. The authors report the case of an extracranial parietooccipital vascular lesion. A 12-year-old boy presented with accelerated growth of a right scalp lesion over a few months. Digital subtraction angiography showed a large, right parietooccipital intraosseous AVM with multiple complex arterial feeders. Treatment of these lesions is difficult and can necessitate a multidisciplinary approach. In the featured case, 6 embolization procedures were performed over 1 year, including both transarterial and transvenous approaches, followed by total resection. The authors describe what is thought to be the second case of an AVM originating in the cranial bones and the first case with successful multidisciplinary management.

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Imaging features of an intraosseous arteriovenous malformation in the tibia

Cited by 7 publications

References 16 publications

Diagnosis and conservative treatment of a rare case of femoral intraosseous arteriovenous malformation in a patient with polyostotic fibrous dysplasia: A case report

Diagnosis and conservative treatment of a rare case of femoral intraosseous arteriovenous malformation in a patient with polyostotic fibrous dysplasia: A case report

A Case of an Aggressive Intraosseous Arteriovenous Malformation in the Lower Extremity: Special Considerations for Diagnosis and Management

The rare case of a large complex intraosseous cranial arteriovenous malformation with successful multidisciplinary management

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