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Kelley N, Hubbard J, Belton M. Cubital tunnel compression neuropathy in the presence of an anomalous venous complex: a case study. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:427-430. [PMID: 37588498 PMCID: PMC10426564 DOI: 10.1016/j.xrrt.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Naomi Kelley
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - James Hubbard
- Department of Orthopedic Surgery, Mercy Hospital St. Louis, St. Louis, MO, USA
| | - Matthew Belton
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
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A Review of Multiple Venous Malformations of the Upper Limb: Classification, Genetics, and Pathogenesis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3391. [PMID: 33564600 PMCID: PMC7861650 DOI: 10.1097/gox.0000000000003391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/02/2020] [Indexed: 11/26/2022]
Abstract
Venous (cavernous) malformations are commonly seen in the upper limb. There is no consensus in the literature regarding the classification of venous malformations. Patients may be viewed as 2 clinical entities: patients with single or multiple lesions. Single venous malformations are sporadic and nonsyndromic, whereas the presence of multiple malformations indicates the presence of either an inherited or an overgrowth (noninherited) disorder. In this article, the author reviews multiple venous malformations of the upper limb, offers a novel classification, and describes their clinical entities along with their genetics and pathogenesis. These clinical entities will also be described by categorizing the cases as per the clinical presentation. Furthermore, the number of cases seen by the author (during an experience of 28 years of practice in Saudi Arabia) in each category will be reviewed to give the reader an overall view of the frequency of presentation of each category to the hand/plastic surgery clinic. Clinically, patients may present in 4 different presentations depending on the distribution of the lesions: the late-onset malformations confined to the upper limb; malformations involving the limbs/face/trunk with no mucosal lesions; widespread malformations of the skin, oral mucosa, and the intestine; and venous malformations presenting as a well-known syndrome. The author has seen a total of 84 patients, and the most 2 common presentations were late-onset type (n = 26) and malformations involving the limbs/face/trunk with no mucosal lesions (n = 36). This is the most comprehensive review of multiple venous malformations of the upper limb.
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Al-Qattan MM, Al-Balwi MA, Al-Zayed EM, Al-Sohaibani M, Gelidan AG, Alsheiban S. Late-onset multiple venous malformations confined to the upper limb: link to somatic MAP3K3 mutations. J Hand Surg Eur Vol 2020; 45:1023-1027. [PMID: 32380920 DOI: 10.1177/1753193420922459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Venous (cavernous) malformations are commonly seen in the upper limb. Almost all venous malformations are congenital. They may be sporadic, familial, or syndromic. Late-onset, multiple venous malformations confined to the upper limb are rare. Lesions present after puberty. All previously reported cases were located subcutaneously and were small in size. The condition is non-hereditary and non-syndromic. We present a unique series of eight patients with this rare condition. Unique features included the presence of large malformations (up to 20 cm in diameter) and the presence of subfascial lesions causing nerve compression. Surgical excision was curative. Mutational analysis in one patient identified a novel somatic MAP3K3 gene mutation (c.1723T > C, p.Tyr 575 His) in the affected veins. The encoded MAP3K3 protein is known to accelerate the RAS pathway of cellular proliferation.Level of evidence: IV.
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Affiliation(s)
| | - Mohammed A Al-Balwi
- King Abdullah International Medical Research, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Pathology and Laboratory Medicine, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | | | | | | | - Saeed Alsheiban
- King Abdullah International Medical Research, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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MR imaging features of presumed retroclavicular and periscapular intermuscular vascular plexi - An observational, anatomic study. Clin Imaging 2018; 52:62-69. [PMID: 29913391 DOI: 10.1016/j.clinimag.2018.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/31/2018] [Accepted: 06/07/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe MR imaging features of presumed vascular plexi in the periscapular (PSC) and retroclavicular (RC) locations. MATERIALS/METHODS 443 consecutive MR studies performed as "brachial plexus" protocol (axialT1-W and sagittal STIR) were reviewed for presence, size and characteristics of PSC and RC plexi. RESULTS Presumed PSC and RC vascular plexi were present in 10%. Both plexi more commonly occurred on the left side. Percutaneous biopsy (n = 1) yielded no vascular neoplasm. CONCLUSION RC and PSC vascular plexi are commonly encountered on routine brachial plexus MR imaging and may represent variant vascular networks, as they are frequently found on the contralateral asymptomatic side.
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Wieck MM, Nowicki D, Schall KA, Zeinati C, Howell LK, Anselmo DM. Management of pediatric intramuscular venous malformations. J Pediatr Surg 2017; 52:598-601. [PMID: 27622586 DOI: 10.1016/j.jpedsurg.2016.08.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/05/2016] [Accepted: 08/21/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intramuscular venous malformations (VMs) are rare, but can be highly symptomatic. There are few reports on outcomes, particularly pain, functional limitations, and muscle contractures. We aimed to compare results of medical management, sclerotherapy, and surgical resection. METHODS We retrospectively reviewed 45 patients with an extremity or truncal intramuscular VM between June 2005 and June 2015 at a single institution. Outcomes were compared between treatment modalities with ANOVA and χ2 tests. RESULTS Six patients (13%) were treated with medical management, 4 (9%) with surgical resection, 23 (51%) with sclerotherapy, and 12 (27%) with both surgery and sclerotherapy. Sclerotherapy alone decreased pain in 72%. Only 20% of patients presented with muscle contracture. For these patients, 33% resolved with sclerotherapy, physical therapy, and aspirin; 22% resolved with surgery, and 45% had persistent contracture. 40% of patients treated with sclerotherapy then surgery developed new muscle contractures, compared to 4% of sclerotherapy only patients and 0% of surgery only patients (p=0.04). CONCLUSIONS Medical management, surgery and sclerotherapy are effective treatments for intramuscular VMs. Observation and supportive care can be a primary treatment for patients with minimal symptomatology and no functional limitations. Sclerotherapy is more effective for treating pain than contractures and when used alone, rarely causes a new muscle contracture.
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Affiliation(s)
- Minna M Wieck
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Donna Nowicki
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Kathy A Schall
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Chadi Zeinati
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Lori K Howell
- Department of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Dean M Anselmo
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
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Intraneural Venous Malformations of the Median Nerve. Arch Plast Surg 2016; 43:371-3. [PMID: 27462571 PMCID: PMC4959981 DOI: 10.5999/aps.2016.43.4.371] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/10/2016] [Accepted: 04/27/2016] [Indexed: 11/21/2022] Open
Abstract
Venous malformations arising from the peripheral nerve are a rare type of vascular malformation. We present the first case of an intraneural venous malformation of the median nerve to be reported in a child and review the previous two cases of median nerve compression due to a venous malformation that have been reported. These cases presented with painless masses in the volar aspect of the wrist or with symptoms suggestive of carpal tunnel syndrome. Clinical suspicion should lead to the use of Doppler ultrasonography as the first-line diagnostic tool. Magnetic resonance imaging and histopathology can confirm the diagnosis, as phleboliths are pathognomonic of venous malformations. Surgical treatment appears to be the only modality capable of successfully controlling the growth of an intraneural malformation. Sclerotherapy and radiotherapy have never been used to treat this type of malformation.
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Low-Flow Vascular Malformation Pitfalls: From Clinical Examination to Practical Imaging Evaluation--Part 2, Venous Malformation Mimickers. AJR Am J Roentgenol 2016; 206:952-62. [PMID: 26999647 DOI: 10.2214/ajr.15.15794] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The purpose of this article is to review the unusual clinical and radiographic features of venous malformations that can give rise to diagnostic confusion. Entities that can have overlapping clinical and imaging features with venous malformations are also reviewed. CONCLUSION Venous malformations are congenital endothelial malformations secondary to errors in vascular morphogenesis and are usually diagnosed in the first 2 decades of life. The clinical and imaging features of venous malformations often overlap those of other pathologic entities, creating diagnostic confusion. Furthermore, the clinical presentation and imaging appearance of venous malformations can vary, making the diagnosis challenging. Thorough knowledge of the various clinical and imaging features not only of venous malformations but also of the major potential mimic lesions is crucial for clinicians caring for patients with these lesions.
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Jiga LP, Rata A, Ignatiadis I, Geishauser M, Ionac M. Atypical venous glomangioma causing chronic compression of the radial sensory nerve in the forearm. A case report and review of the literature. Microsurgery 2012; 32:231-4. [PMID: 22407591 DOI: 10.1002/micr.20983] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Revised: 10/25/2011] [Accepted: 10/28/2011] [Indexed: 11/10/2022]
Abstract
Extrinsic chronic nerve compression induced by nonendothelium derived vascular tumors is a rare occurrence at the forearm level. We present a case of severe chronic compression of the radial sensory nerve (RSN) caused by an undiagnosed venous glomangioma. The tumor was excised with complete symptoms relief. In the presence of severe nerve compression syndromes in young age, without predisposing comorbidities, atypical extrinsic compression due to vascular tumors should be considered.
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Affiliation(s)
- Lucian P Jiga
- Division of Reconstructive Microsurgery, Department for Vascular Surgery, Victor Babes University of Medicine and Pharmacy, Piata Eftimie Murgu 2,Timisoara, Romania.
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Hariri A, Cohen G, H. Masmejean E. Venous malformation involving median nerve causing acute carpal tunnel syndrome. J Hand Surg Eur Vol 2011; 36:431-2. [PMID: 21490029 DOI: 10.1177/1753193411405946] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Amir Hariri
- Hand and Nerve Surgery Unit, Paris Descartes University, Georges-Pompidou European Hospital (HEGP), Paris, France
| | - Gilles Cohen
- Hand and Nerve Surgery Unit, Paris Descartes University, Georges-Pompidou European Hospital (HEGP), Paris, France
| | - Emmanuel H. Masmejean
- Hand and Nerve Surgery Unit, Paris Descartes University, Georges-Pompidou European Hospital (HEGP), Paris, France
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Patten DK, Wani Z, Kamineni S. Intramuscular cavernous haemangioma of the triceps. Int J Surg Case Rep 2011; 2:86-9. [PMID: 22096691 DOI: 10.1016/j.ijscr.2011.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 02/09/2011] [Accepted: 02/21/2011] [Indexed: 11/18/2022] Open
Abstract
Haemangiomas are one of the most common soft tissue tumours comprising 7% of all benign tumours. Vascular malformations are often confused with haemangiomas. The etiology is unknown. They are common in infancy and childhood and females are more commonly affected. These tumours may be superficial or deep, and deeply seated lesions, are difficult to diagnose clinically and hence require radiographic assessment. Deep-seated haemangiomas are usually intramuscular, although intra-articular synovial haemangiomas also occur. The commonest anatomic site is the lower limb.Despite their vascular origin, haemangiomas do not metastasize or undergo malignant transformation. Many treatment modalities for the symptomatic haemangioma are available but surgical excision is the preferred treatment. We present an unusual case of a dumb-bell intramuscular haemangioma involving the triceps and extending into the cubital tunnel of the elbow, distinguish between haemangiomas and vascular malformations and emphasize the importance of surgical technique in ensuring ulnar nerve safety.
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Affiliation(s)
- D K Patten
- Department of Biosurgery and Surgical Oncology, St Mary's Hospital, Imperial College Healthcare Trust, London, UK
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Ozaki M, Kurita M, Kaji N, Fujino T, Narushima M, Takushima A, Harii K. Efficacy and evaluation of safety of sclerosants for intramuscular venous malformations: Clinical and experimental studies. J Plast Surg Hand Surg 2010; 44:75-87. [DOI: 10.3109/02844310903569725] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Fnini S, Messoudi A, Benjeddi Y, Elandaloussi Y, Hassoun J, Garche A, Ouarab M, Largab A. [Intramuscular hemangioma of the forearm: seven cases]. ANN CHIR PLAST ESTH 2010; 58:243-7. [PMID: 20880625 DOI: 10.1016/j.anplas.2010.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 08/13/2010] [Indexed: 11/17/2022]
Abstract
The authors reexamined the files of seven patients dealt with for intramuscular hemangioma of forearm. It concerns five women and two men, between 16 and 39 years old. The average time of consultation was 13 months. The clinical signs were dominated by the development of a generally painless soft mass over the anterior compartment of the forearm and/or the elbow. Two patients presented nervous lesions signs of the ulnar or median nerves. The feeder pedicle was the ulnar artery in five cases and radial artery in two cases. The excision was incomplete in two cases because of the invasion of the ulnar nerve by the hemangioma. With four years average follow-up, the five patients having undergone a complete excision do not present a recurrence and the hand function is excellent. The authors insist on the interest of a preoperative diagnosis with the IRM, which permits to envisage surgical difficulties due to the proximity of vascular and nervous pedicles.
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Affiliation(s)
- S Fnini
- Service de chirurgie orthopédique et traumatologique, pavillon 32, CHU Ibn Rochd, Casablanca, Morocco.
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