Soft-Tissue Venous Malformations in Adult Patients: Imaging and Therapeutic Issues

Abstract

Venous malformations are the most common vascular malformations. However, confusion with respect to terminology and imaging guidelines continues to result in improper diagnosis and treatment. An appropriate classification scheme for vascular anomalies is important to avoid the use of false generic terms. Adequate imaging in association with clinical findings is crucial to establishing the correct diagnosis. Doppler ultrasonography should be the initial imaging modality and demonstrates absence of flow or low-velocity venous flow. Computed tomography and magnetic resonance (MR) imaging are used primarily for pretreatment evaluation of lesion extension. These lesions are usually hypointense on T1-weighted MR images and markedly hyperintense on T2-weighted images with variable gadolinium enhancement. Direct phlebography helps confirm the diagnosis and exclude other soft-tissue tumors. Three distinct phlebographic patterns (cavitary, spongy, dysmorphic) have been identified. In most cases, conservative treatment is recommended. Sclerotherapy with or without surgery is useful in cases of functional impairment or significant aesthetic prejudice, even if recurrences are frequent. Direct phlebography is performed when a more detailed assessment of the vascular pattern is needed or as part of sclerotherapy. Use of the appropriate imaging technique is critical in establishing the diagnosis, evaluating extension, and planning appropriate treatment.

Multiple Low Flow Vascular Malformation with Phleboliths – A Case Report

“…Angiography is also a useful modality for defining extent of disease, especially when identifying deep or small VMs, such as intracranial sinus pericranii or gastrointestinal VM. [12][13][14][15][16][17][18][19][20] In the present case, phleboliths were seen on plain radiography and were suggestive of vascular anomaly with slow flow rate. Whereas, by direct phlebography the lesion was seen draining the regional vein.…”

“…12 Venous malformation is defined as malformations comprised of slow-flowing, abnormal dilated veins, and venous network. 13 Clinically, these lesions appear as a soft, compressible and blue mass, typically present within the cutaneous tissues of the face, trunk, and limbs, although involvement of the viscera and bones has also been described, as seen in the present case. It is noted that two thirds of all vascular malformations are venous predominant (Table 3).…”

Percutaneous Sclerotherapy for Facial Venous Malformations: Subjective Clinical and Objective MR Imaging Follow-Up Results

“…[1][2][3] Diagnosis is typically based on clinical presentation, with confirmation by MR imaging largely recognized as the criterion standard. 1,[4][5][6] The classic MR appearance is that of a soft tissue mass that is hyperintense on T2-weighted images and hypointense on T1-weighted images. Multiple, rounded signal intensity voids representing phleboliths may be noted.…”

Venous malformations: clinical diagnosis and treatment

“…The reduced size of the lesion is noted and treated segments have an elevated heterogeneity, diminished STIR and T2 signal intensity and decreased contrast enhancement. This information allows planning a future procedure for the untreated sections (37,39).…”

“…US can be performed in between sessions and after 1 month of the last ethanol therapy (55). MRI evaluation should occur annually after the final ethanol treatment in order to allow inflammation to subside and provide an accurate assessment of the treatment's effectiveness and growth of any remaining VMs, although some advocate MRI follow-up as early as 1 to 3 months (37). Difficult lesions may benefit from intermittent ethanol sclerotherapy and medication in lieu of surgical intervention.…”