Imaging of Vascular Lesions of the Head and Neck

Parapharyngeal Space Venous Malformation: An Imaging Mimic of Pleomorphic Adenoma

“…Evaluation of head and neck vascular anomalies is heavily dependent on MR imaging, which has excellent spatial resolution and soft-tissue contrast, allowing both lesion characterization and assessment of extent for pretreatment planning. [1][2][3]19,20 This dependence on MR Imaging is particularly true for PPS VMs, which may not be detectable by palpation or skin discoloration. Because of the rich slow-flowing venous blood supply, VMs are T2 hyperintense and T1 intermediate on MR imaging, and signal voids may be present in the case of phleboliths.…”

“…23 At sonography, VMs appear as lobulated hypoechoic masses with small internal venous channels. 3 On spectral Doppler imaging, waveforms are venous, and a curvilinear hyperechoic focus with posterior shadowing may be identified if phleboliths are present.…”

“…Although "cavernous hemangioma" is a colloquial term that remains in use, it has been increasingly recognized that many such lesions are actually low-flow VMs as opposed to hemangiomas, with the latter being a true neoplasm. [1][2][3][4] In 1982, Mulliken and Glowacki 5 proposed a biologic classification scheme that categorized vascular anomalies on the basis of the rate of cell turnover, histology, natural history, and examination findings. The current International Society for the Study of Vascular Anomalies classification system is grounded in this sentinel work, which groups vascular anomalies into 2 categories: tumors and malformations.…”

“…[7][8][9] Both VM and pleomorphic adenoma may appear as a wellcircumscribed, mildly lobulated enhancing mass that is isodense to muscle on CT and markedly T2 hyperintense on MR imaging. 1,3,10,11 As a result, distinguishing these 2 entities when they occur in the PPS can be challenging, and this distinction is clinically important because management for salivary gland tumor and VM may differ. To date, very few case reports have published the imaging features of patients with primary PPS VMs, which have been frequently described as "hemangiomas," reflecting the controversial ongoing use of older nomenclature.…”

American Thoracic Society 2019 Pediatric Core Curriculum

“…Prenatal detection can be achieved with ultrasound or fetal magnetic resonance imaging (MRI) . Doppler ultrasound and MRI are important initial modalities to morphologically characterize the malformation, determine extension, and plan appropriate treatment . Given the lymph component, increased signal on T2‐weighted images is characteristic, with gadolinium helping to differentiate LM from venous malformation.…”