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Lackermair S, Egermann H, Müller F, Töpel I, Zustin J, Mülle A. Local compression of the sciatic nerve by a vascular malformation as a rare cause of sciatica: A case report and review of literature. Surg Neurol Int 2024; 15:139. [PMID: 38741994 PMCID: PMC11090559 DOI: 10.25259/sni_132_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/30/2024] [Indexed: 05/16/2024] Open
Abstract
Background Sciatica is typically caused by disc herniations or spinal stenosis. Extraspinal compression of the sciatic nerve is less frequent. Case Description We report a rare case of sciatica with compression of the sciatic nerve by a low-flow vascular malformation in a 24-year-old female patient. The special feature of this case was sciatica along the S1 dermatome, which only occurred in the sitting position and inclination because of compression of the sciatic nerve between the vascular malformation and the lesser trochanter. Spinal imaging showed no abnormal findings. Surgery was performed interdisciplinary and included neurosurgery, vascular surgery, and trauma surgery. After surgery, the patient became symptom-free. Conclusion Rare and extraspinal causes of local compression of the sciatic nerve should be considered, especially in cases of lacking spinal imaging correlation and untypical clinical presentation. Interdisciplinary surgical cooperation is of special value in cases of rare entities and uncommon locations.
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Affiliation(s)
- Stephan Lackermair
- Department of Neurosurgery, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - Hannes Egermann
- Department of Neurosurgery, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - Franz Müller
- Department for Trauma, Orthopaedics and Sports Medicine, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - Ingolf Töpel
- Department of Vascular Surgery, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - Jozef Zustin
- Pathological-Anatomical Institute, Regensburg, Germany
| | - Adolf Mülle
- Department of Neurosurgery, Krankenhaus Barmherzige Brüder, Regensburg, Germany
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Nagata S, Tanaka N, Kuhara A, Kugiyama T, Tanoue S, Koganemaru M, Uchiyama Y, Fujimoto K, Abe T. Value of fat-suppressed T2-weighted imaging for predicting short-term pain relief after sclerotherapy for venous malformations in the extremities. Jpn J Radiol 2023; 41:1157-1163. [PMID: 37170024 PMCID: PMC10543150 DOI: 10.1007/s11604-023-01442-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 05/03/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE This study aimed to evaluate the value of fat-suppressed T2-weighted imaging (FS-T2WI) for predicting short-term pain relief after polidocanol sclerotherapy for painful venous malformations (VMs) in the extremities. MATERIALS AND METHODS This retrospective study included patients with painful VMs in the extremities between October 2014 and September 2021, had their first sclerotherapy without history of surgical therapy, and underwent magnetic resonance imaging before sclerotherapy. Pain relief was assessed 2 months after 3% polidocanol sclerotherapy and was categorized as follows: progression, no change, partial relief, or free of pain. The associations between pain relief and imaging features on FS-T2WI were analyzed. RESULTS The study included 51 patients. The no change, partial relief, and free of pain groups included 6 (11.8%), 25 (49.0%), and 20 (39.2%) patients, respectively. No patient experienced progressive pain. The lesion diameter was ≤ 50 mm in 13 (65.0%) patients in the free of pain group, whereas it was > 50 mm in all patients in the no change group (p = 0.019). The lesions showed well-defined margin in 15 (75.0%) patients in the free of pain group, whereas they showed ill-defined margin in 5 (83.3%) patients in the no change group (p = 0.034). The most common morphological type was cavitary in the free of pain group (14 [70.0%] patients), whereas there was no patient with cavitary type lesion in the no change group (p = 0.003). Drainage vein was demonstrated in 6 (100%), 22 (88.0%), and 11 (55.0%) patients in the no change, partial relief, and free of pain group, respectively (p = 0.011). CONCLUSION A lesion size of 50 mm or less, a well-defined margin, a cavitary type, and no drainage vein on FS-T2WI were significant features for predicting short-term pain relief after polidocanol sclerotherapy for painful VMs in the extremities.
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Affiliation(s)
- Shuji Nagata
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka 830-0011 Japan
| | - Norimitsu Tanaka
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka 830-0011 Japan
| | - Asako Kuhara
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka 830-0011 Japan
| | - Tomoko Kugiyama
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka 830-0011 Japan
| | - Shuichi Tanoue
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka 830-0011 Japan
| | - Masamichi Koganemaru
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka 830-0011 Japan
| | - Yusuke Uchiyama
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka 830-0011 Japan
| | - Kiminori Fujimoto
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka 830-0011 Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka 830-0011 Japan
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Menon NN, Bharathi MB. Rare Presentation of Venous Malformation in Parapharyngeal Space. Indian J Otolaryngol Head Neck Surg 2023; 75:2453-2455. [PMID: 37636612 PMCID: PMC10447762 DOI: 10.1007/s12070-023-03683-8] [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: 01/18/2022] [Accepted: 03/05/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Venous malformations are commonly seen in muscles like masseter, temporalis, tongue musculature, oral and airway mucosa in the head and neck region but is rarely seen in parapharyngeal space. Case Summary We report a case of a 60 year female patient who presented with foreign body sensation of throat, sticky sensation and dysphagia to solids for 2 years. She was subjected to relevant investigations including MRI and USG guided FNAC. Following which she underwent endoscopic parapharyngeal space tumour excision and specimen was sent for HPE. Post operatively patient is doing well and symptomatically better. She is being followed up on regular basis. Conclusion Parapharyngeal space tumours accounts for only 0.5% of head and neck tumours, of which 70 to 80% are benign and the rest are malignant. Out of the benign tumours of parapharyngeal space we should also keep in mind rare tumours like venous malformations.
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Affiliation(s)
- Nandini N Menon
- Department of Surgical oncology, BLK- MAX Super speciality hospital, Pusa road, Rajendra Place, Delhi, 110005 India
| | - M B Bharathi
- ENT and Head and Neck surgery, JSS Medical college and hospital, Mysore, Karanataka India
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Israrahmed A, Singh V, Prasad SN, Singh AK, Bhatnagar A, Singh A, Phadke RV. Management of scalp arteriovenous malformations: a rising trend towards percutaneous direct puncture embolization technique-our experience. Acta Radiol 2023; 64:2431-2438. [PMID: 37192645 DOI: 10.1177/02841851231174458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Scalp arteriovenous malformations (AVMs), or cirsoid aneurysms of the scalp, usually present with troublesome symptoms and cosmetic disfigurement. Endovascular/percutaneous embolization has evolved as a sole treatment method or adjunct to surgical excision in the management of scalp AVMs with an excellent outcome. PURPOSE To discuss minimally invasive techniques for treating scalp AVMs as well as to highlight the role of embolization before surgery. MATERIAL AND METHODS This is a retrospective study of 50 patients with scalp AVM who underwent embolization (percutaneous/endovascular) during 2010-2019 at a tertiary care center. n-butyl cyanoacrylate (n-BCA) was used as an embolizing agent in all the cases and the patients were followed up at three- and six-month intervals with Doppler evaluation. RESULTS A total of 50 patients were included in the study. The occipital region was the most common location; 82% were Schobinger class II lesions and 18% were class III lesions. Thirteen patients had small-sized AVMs and 37 patients had large-sized AVMs. Post-embolization surgery was performed in 36 patients. Of the patients, 28 underwent percutaneous embolization, 20 underwent endovascular embolization, and two underwent both to achieve complete embolization of the lesion. The number of percutaneous procedures increased in the latter half of the study period as the safety and efficacy of the technique were established. No major complications were seen in this study. CONCLUSION Embolization of scalp AVMs is a safe and effective technique and can be used in isolation for small lesions and as an adjunct procedure to surgery for large-sized lesions.
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Affiliation(s)
- Amrin Israrahmed
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Vivek Singh
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Surya Nandan Prasad
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, India
| | - Anil Kumar Singh
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ankur Bhatnagar
- Department of Plastic Surgery and Burns, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Anupama Singh
- Department of Plastic Surgery and Burns, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Arasakumar DRB, Pang C, Evans N, Papadopoulou A, Khalifa M, Tsui J, Hamilton G, Brookes J, Lim CS. Efficacy and safety of foam sclerotherapy with sodium tetradecyl sulfate as preferred sclerosant of venous malformations based on experience from a single specialist center. J Vasc Surg Venous Lymphat Disord 2023; 11:379-388. [PMID: 36328136 DOI: 10.1016/j.jvsv.2022.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/13/2022] [Accepted: 10/24/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE We have assessed the efficacy and safety of interventional therapy for venous malformations (VMs), with foam sclerotherapy as the treatment of choice according to our experience at a single specialist center. METHODS All the patients with VMs who had undergone interventional therapy (ie, embolo-sclerotherapy and/or open surgery) from January 1, 2015 to December 31, 2019 were identified through a prospective database. The VM types were classified according to the Puig classification. The outcome measures assessed included the efficacy and complications. The former was divided into four groups: no response, mild response, moderate response, and complete response. The complications were defined as any tissue or functional damage, distal embolization, or tissue reaction. The continuous variables were compared using the analysis of variance F test, and discrete variables were analyzed using the χ2 tests. P values < .05 were considered statistically significant. RESULTS A total of 207 patients were included. Puig type I lesions were significantly less likely to have received foam sclerotherapy using sodium tetradecyl sulfate (STS) 3% (P ≤ .001) and more likely to have been surgically excised (P ≤ .001). At the patient's first procedure during the study period, the volumes of foam STS 3% were significantly different across all types of VM (P ≤ .001). The patients with type I VMs had received a lower volume of STS 3% compared with those with type II and III VMs. The efficacy outcome categories were significantly different across all types of VMs (P ≤ .001). Overall, only 14 patients (6.8%) had reported no improvement in efficacy, and 38 patients (18%) had not attended follow-up. Therefore, 154 patients (74.8%) had experienced some form of efficacious outcome. Ten patients (4.8%) had developed complications such as hematoma, thrombophlebitis, and ulceration. The incidence of complications differed significantly across the categories (P = .030), with more complications reported for those with type I VMs. CONCLUSIONS We found that intervention with foam sclerotherapy using STS 3% is clinically effective and safe for patients with VMs and was most successful for those with Puig type I and II VMs.
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Affiliation(s)
| | - Calver Pang
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, Department of Surgical Biotechnology, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Nicholas Evans
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Anthie Papadopoulou
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Mohamed Khalifa
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Janice Tsui
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, Department of Surgical Biotechnology, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - George Hamilton
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, Department of Surgical Biotechnology, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Jocelyn Brookes
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom; Department of Interventional Radiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Chung Sim Lim
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom; Division of Surgery and Interventional Science, Department of Surgical Biotechnology, Faculty of Medical Sciences, University College London, London, United Kingdom.
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Das A, Goyal A, Sangwan A, Bhalla AS, Kumar A, Kandasamy D, Dawar R. Vascular anomalies: nomenclature, classification, and imaging algorithms. Acta Radiol 2023; 64:837-849. [PMID: 35414244 DOI: 10.1177/02841851221082241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is a lot of ambiguity in the usage of correct terminology in the description of vascular malformations and tumors. Hemangioma and arteriovenous malformation (AVM) are the most commonly used terms and are the mostly incorrectly used as well! The aim of this review article was to lay out the correct nomenclature and describe the correct usage for the physicians and radiologists involved in diagnosing and managing these lesions. We describe the various classification systems which have been devised to define the multiple entities included under vascular anomalies. The latest classification system that should be adhered to is per the International Society for the Study of Vascular Anomalies, approved at the 20th ISSVA Workshop held in Melbourne in April 2014, last revised in May 2018. The main features of the latest revision have been highlighted. This classification, however, does not list the diagnostic clinico-radiological features for each entity. In addition, guidelines regarding the appropriate use of available imaging modalities are lacking in the literature. We, hereby, aim to address these pertinent issues in this review article.
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Affiliation(s)
- Abanti Das
- Department of Radiodiagnosis, and Interventional Radiology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiodiagnosis, and Interventional Radiology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Sangwan
- Department of Radiodiagnosis, and Interventional Radiology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis, and Interventional Radiology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Atin Kumar
- Department of Radiodiagnosis, and Interventional Radiology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Devasenathipathy Kandasamy
- Department of Radiodiagnosis, and Interventional Radiology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Dawar
- Department of Plastic, Reconstructive and Burns Surgery, Department of Radiodiagnosis and Interventional Radiology, 28730All India Institute of Medical Sciences, New Delhi, India
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Lavé A, Yilmaz H, Rosi A, Paun L, Patet G, Bartoli A. Combined sclerotherapy followed by surgical resection of a large extracranial venous malformation in a 14-month-old child: preoperative workup and technical note. Childs Nerv Syst 2023; 39:527-533. [PMID: 35962221 PMCID: PMC10006260 DOI: 10.1007/s00381-022-05643-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/03/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Venous malformations affect around 2 per 10,000 newborn and are the most common type of congenital vascular malformation. They are always present at birth and are often misdiagnosed with hemangiomas. Accurate diagnosis and adequate targeted therapy through a multidisciplinary approach is advocated for a successful treatment, considering a combination of modalities in complex cases. We present here the workup and treatment of a venous malformation in a 14 month old child by combining a preoperative sclerotherapy with sodium tetradecyl sulfate (STS) followed by complete surgical excision respecting the calvarium. CASE PRESENTATION A large right extracranial fronto-parietal venous malformation and scalloping of the underlying calvarium, attached to the pericranium, surgically excised after preoperative sclerotherapy with STS in a 14-month-old child. RESULTS The patient had an uneventful postoperative course with complete resection of the lesion, satisfying cosmetic appearance and no complications. Histopathological examination confirmed a venous malformation. CONCLUSION We demonstrated the workup and the rationale of the combined sclerotherapy followed by surgical resection of a large growing extracranial venous malformation. Preoperative direct contrast injection and sclerotherapy allowed to rule out significative extracranial to intracranial venous inflow and reduce blood loss for the surgical procedure, respectively. Complete removal of the malformation minimized the impact on future growth of the calvarium.
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Affiliation(s)
- Alexandre Lavé
- Division of Neurosurgery, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
| | - Hasan Yilmaz
- Division of Diagnostic and Interventional Neuroradiology, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Andrea Rosi
- Division of Diagnostic and Interventional Neuroradiology, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Luca Paun
- Division of Neurosurgery, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Gildas Patet
- Division of Neurosurgery, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Andrea Bartoli
- Division of Neurosurgery, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
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Burke CJ, Fritz J, Samim M. Musculoskeletal Soft-tissue Masses. Magn Reson Imaging Clin N Am 2023; 31:285-308. [PMID: 37019551 DOI: 10.1016/j.mric.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Evaluation of soft-tissue masses has become a common clinical practice indication for imaging with both ultrasound and MR imaging. We illustrate the ultrasonography and MR imaging appearances of soft-tissue masses based on the various categories, updates, and reclassifications of the 2020 World Health Organization classification.
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Affiliation(s)
- Christopher J Burke
- NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY 10003, USA.
| | - Jan Fritz
- NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY 10003, USA
| | - Mohammad Samim
- NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY 10003, USA
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9
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Ganesan A, Hegde AI, Ghosh TS, Chaudhry K. Venolymphatic malformation of tongue: a prompt life saving intervention. BMJ Case Rep 2022; 15:e252437. [PMID: 36450418 PMCID: PMC9717346 DOI: 10.1136/bcr-2022-252437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Venolymphatic malformations (VLMs) of the head and neck can have varied clinical presentation with associated complications. Timely diagnosis and treatment is warranted to curb the morbidity and obtain satisfactory outcomes. We present the case of a male patient in his early 20s with VLM of the tongue who received precise interventions which were executed with active contributions from a team of anaesthesiologists, interventional radiologists, oral and maxillofacial surgeons and intensivists. We highlight the importance of an immediate, comprehensive and multimodal treatment approach for VLMs of the maxillofacial region.
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Affiliation(s)
- Aparna Ganesan
- Oral & Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India
| | - Adarsh Ishwar Hegde
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Tushar Suvra Ghosh
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Kirti Chaudhry
- Additional Professor, Oral & Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India
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10
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Patel ND, Chong AT, Kolla AM, Mabud TS, Kulkarni K, Masrouha K, Taslakian B, Bertino FJ. Venous Malformations. Semin Intervent Radiol 2022; 39:498-507. [PMID: 36561936 PMCID: PMC9767763 DOI: 10.1055/s-0042-1757940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Venous malformations, the most common type of vascular malformation, are slow-flow lesions resulting from disorganized angiogenesis. The International Society for the Study of Vascular Anomalies (ISSVA) classification offers a categorization scheme for venous malformations based on their genetic landscapes and association with congenital overgrowth syndromes. Venous malformations present as congenital lesions and can have broad physiologic and psychosocial sequelae depending on their size, location, growth trajectory, and tissue involvement. Diagnostic evaluation is centered around clinical examination, imaging evaluation with ultrasound and time-resolved magnetic resonance imaging, and genetic testing for more complex malformations. Interventional radiology has emerged as first-line management of venous malformations through endovascular treatment with embolization, while surgery and targeted molecular therapies offer additional therapeutic options. In this review, an updated overview of the genetics and clinical presentation of venous malformations in conjunction with key aspects of diagnostic imaging and treatment are discussed.
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Affiliation(s)
- Nihal D. Patel
- Division of Vascular and Interventional Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, New York
| | - Anthony T. Chong
- Division of Vascular and Interventional Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, New York
| | - Avani M. Kolla
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York
| | - Tarub S. Mabud
- Division of Vascular and Interventional Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, New York
| | - Kopal Kulkarni
- Division of Vascular and Interventional Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, New York
| | - Karim Masrouha
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, New York
| | - Bedros Taslakian
- Division of Vascular and Interventional Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, New York
| | - Frederic J. Bertino
- Division of Vascular and Interventional Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, New York
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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11
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Axillary vascular malformation visualized on mammogram: A case report. Radiol Case Rep 2022; 17:2902-2905. [PMID: 35733950 PMCID: PMC9207552 DOI: 10.1016/j.radcr.2022.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/07/2022] [Accepted: 05/12/2022] [Indexed: 11/23/2022] Open
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12
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Pahl KS, Pabon-Ramos WM, Jeng MR. How we approach localized vascular anomalies. Pediatr Blood Cancer 2022; 69 Suppl 3:e29321. [PMID: 36070210 DOI: 10.1002/pbc.29321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 01/19/2023]
Abstract
Vascular anomalies are a group of disorders divided into two distinct subtypes: vascular tumors and vascular malformations. Vascular tumors are proliferative in nature, while malformations are nonproliferative. Simple, localized vascular malformations refer to a group of malformations that are localized to a single area of involvement. These simple malformations include capillary, lymphatic, venous, and arteriovenous malformations. The pediatric hematologists and oncologists are becoming increasingly involved in the diagnosis and management of these disorders. This review presents four cases as a means to discuss the diagnosis, clinical and imaging features, and management strategies of simple, localized vascular malformations.
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Affiliation(s)
- Kristy S Pahl
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Waleska M Pabon-Ramos
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael R Jeng
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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13
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Kim H, Labropoulos N. Ultrasound Examination of Venous Malformation. Phlebology 2022. [DOI: 10.37923/phle.2022.20.1.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hyangkyoung Kim
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Nicos Labropoulos
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
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14
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Neonatal vascular anomalies manifesting as soft-tissue masses. Pediatr Radiol 2022; 52:786-801. [PMID: 34374837 DOI: 10.1007/s00247-021-05149-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/25/2021] [Accepted: 06/28/2021] [Indexed: 01/19/2023]
Abstract
The broad and heterogeneous spectrum of vascular anomalies ranges from an innocuous localized cutaneous discoloration to complex, extensive and life-threatening diagnoses. While many of these lesions are present at birth, smaller and deeper lesions might be clinically occult for months or years. Certain vascular anomalies commonly manifest in the prenatal or neonatal period and often have suggestive clinical and imaging features that can aid the radiologist in making a correct diagnosis. The characteristics of such lesions presenting very early in life, particularly those manifesting as soft-tissue masses, are the focus of this review.
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15
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Kang K, Kirberger RM, Hosgood G, Stander N. Computed tomographic, ultrasonographic, MRI and radiographic findings of a venous malformation with phleboliths in the thoracic limb of a dog. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Kevin Kang
- Diagnostic Imaging Department School of Veterinary Medicine Murdoch University Perth Western Australia Australia
| | - Robert M. Kirberger
- Department of Companion Animal Clinical Studies Faculty of Veterinary Science University of Pretoria Pretoria South Africa
| | - Giselle Hosgood
- Small Animal Surgery Department School of Veterinary Medicine Murdoch University Perth Western Australia Australia
| | - Nerissa Stander
- Vet Imaging Specialists The Animal Hospital, Murdoch University Perth Western Australia Australia
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16
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Liu Z, Hu W, Sun J, Wang L, Song D, Guo L. Effectiveness of Polidocanol in the Treatment of Venous Malformations: A Meta-Analysis. Front Pediatr 2022; 10:925318. [PMID: 35967557 PMCID: PMC9370826 DOI: 10.3389/fped.2022.925318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/09/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the efficacy of polidocanol against venous malformations (VMs). METHODS Studies reporting the treatment of VMs using polidocanol (published until February 15, 2020) were reviewed in the Embase and PubMed databases. After excluding the same literature, part of the studies were excluded by reading the title, abstract, full text. Eleven studies (with 287 participants) that fulfilled the inclusion criteria were included. Systematic meta-analysis was performed using Reviews Manager 5.2, and a fixed-effects model was used to calculate the pooled effective rate of polidocanol against VMs and the 95% confidence intervals (CI). RESULTS Lesion reduction of more than 50% was considered effective. A total of 287 patients were treated, and treatment in 271 was considered effective. The efficacy of polidocanol was 0.89 (95% CI = 0.83-0.93). Heterogeneity among the studies was small (I 2 = 0%, P = 0.47). T The funnel plot was roughly symmetric. CONCLUSION Our study suggested that polidocanol is effective in the treatment of VMs. VMs at different sites can be treated without serious complications. Therefore, we have reason to believe that polidocanol is a safe and an effective drug for VMs.
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Affiliation(s)
- Zhuang Liu
- Children's Hospital Affiliated to Shandong University, Jinan, China.,Department of Vascular Anomalies and Interventional Radiology, Jinan Children's Hospital, Jinan, China
| | - Wei Hu
- Children's Hospital Affiliated to Shandong University, Jinan, China.,Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, China
| | - Jiali Sun
- Children's Hospital Affiliated to Shandong University, Jinan, China.,Department of Vascular Anomalies and Interventional Radiology, Jinan Children's Hospital, Jinan, China
| | - Liang Wang
- Children's Hospital Affiliated to Shandong University, Jinan, China.,Department of Vascular Anomalies and Interventional Radiology, Jinan Children's Hospital, Jinan, China
| | - Dan Song
- Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Lei Guo
- Children's Hospital Affiliated to Shandong University, Jinan, China.,Department of Vascular Anomalies and Interventional Radiology, Jinan Children's Hospital, Jinan, China.,Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, China
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17
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Colafati GS, Piccirilli E, Marrazzo A, Carboni A, Diociaiuti A, El Hachem M, Esposito F, Zama M, Rollo M, Gandolfo C, Tomà P. Vascular lesions of the pediatric orbit: A radiological walkthrough. Front Pediatr 2022; 10:734286. [PMID: 36533238 PMCID: PMC9748295 DOI: 10.3389/fped.2022.734286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/03/2022] [Indexed: 12/05/2022] Open
Abstract
Vascular anomalies of the pediatric orbit represent a heterogeneous group that include both vascular tumors and vascular malformations. The disorder may initially be silent and then associated with symptoms and/or function damage, depending on the type of vascular anomaly and its extension. Vascular tumors include benign, locally aggressive (or borderline) and malignant forms while vascular malformations are divided into "simple", "combined" and syndromic, or "low flow" or "high flow". Both entities can arise in isolation or as part of syndromes. In this review, we describe the imaging findings of the vascular lesions of the orbit in the pediatric population, which are key to obtain a correct diagnosis and to guide the appropriate treatment in the light of the new genetic and molecular discoveries, and the role of the radiologist in their multidisciplinary management. We will also touch upon the main syndromes associated with orbital vascular abnormalities.
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Affiliation(s)
| | - Eleonora Piccirilli
- Department of Neuroscience, Imaging and Clinical Science, University "G. d'Annunzio" of Chieti, Chieti, Italy
| | - Antonio Marrazzo
- Neuroradiology Unit, Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessia Carboni
- Neuroradiology Unit, Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Andrea Diociaiuti
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - May El Hachem
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesco Esposito
- Department of Radiology, Santobono-Pausilipon Children Hospital, Naples, Italy
| | - Mario Zama
- Craniofacial Centre-Plastic and Maxillofacial Surgery Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Massimo Rollo
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Carlo Gandolfo
- Neuroradiology Unit, Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Paolo Tomà
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
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18
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Schmidt VF, Masthoff M, Czihal M, Cucuruz B, Häberle B, Brill R, Wohlgemuth WA, Wildgruber M. Imaging of peripheral vascular malformations - current concepts and future perspectives. Mol Cell Pediatr 2021; 8:19. [PMID: 34874510 PMCID: PMC8651875 DOI: 10.1186/s40348-021-00132-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/25/2021] [Indexed: 12/17/2022] Open
Abstract
Vascular Malformations belong to the spectrum of orphan diseases and can involve all segments of the vascular tree: arteries, capillaries, and veins, and similarly the lymphatic vasculature. The classification according to the International Society for the Study of Vascular Anomalies (ISSVA) is of major importance to guide proper treatment. Imaging plays a crucial role to classify vascular malformations according to their dominant vessel type, anatomical extension, and flow pattern. Several imaging concepts including color-coded Duplex ultrasound/contrast-enhanced ultrasound (CDUS/CEUS), 4D computed tomography angiography (CTA), magnetic resonance imaging (MRI) including dynamic contrast-enhanced MR-angiography (DCE-MRA), and conventional arterial and venous angiography are established in the current clinical routine. Besides the very heterogenous phenotypes of vascular malformations, molecular and genetic profiling has recently offered an advanced understanding of the pathogenesis and progression of these lesions. As distinct molecular subtypes may be suitable for targeted therapies, capturing certain patterns by means of molecular imaging could enhance non-invasive diagnostics of vascular malformations. This review provides an overview of subtype-specific imaging and established imaging modalities, as well as future perspectives of novel functional and molecular imaging approaches. We highlight recent pioneering imaging studies including thermography, positron emission tomography (PET), and multispectral optoacoustic tomography (MSOT), which have successfully targeted specific biomarkers of vascular malformations.
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Affiliation(s)
- Vanessa F Schmidt
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Masthoff
- Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | - Michael Czihal
- Angiology Division, Department for Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Beatrix Cucuruz
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Beate Häberle
- Department for Pediatric Surgery, Dr. von Haunersches Kinderspital, University Hospital, LMU Munich, Munich, Germany
| | - Richard Brill
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Walter A Wohlgemuth
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany. .,Clinic for Radiology, University Hospital Muenster, Muenster, Germany.
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19
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Therapeutic Effect of Polidocanol Sclerotherapy on Oral Vascular Malformations. Dent J (Basel) 2021; 9:dj9100119. [PMID: 34677181 PMCID: PMC8534538 DOI: 10.3390/dj9100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022] Open
Abstract
Various treatments for oral vascular malformation (VM) have been reported. Polidocanol and absolute ethanol have also been reported for sclerotherapy. However, there are still few reports on the therapeutic effect and dosage of polidocanol sclerotherapy. Therefore, we examined its therapeutic effects on oral VM. There were 17 sites of VMs, with nine patients diagnosed with oral VM at the Department of Dental and Oral Surgery, Tsukuba University Hospital. The medical records were retrospectively investigated to determine the site, hemangioma volume, polidocanol injection volume, and therapeutic effect. The volume of hemangiomas was calculated using magnetic resonance images. Based on the site, oral VMs were observed in the tongue, buccal mucosa, lips, and oral floor in eight, three, five, and one patients, respectively. The average size of the site was 3071 mm3. The average injection dose of polidocanol at one site was 2.86 mL, the average number of administrations was 1.6, and the response rate was 88.2%. No adverse events were observed. The median numerical rating scale scores were 2/10 (0–6/10) and 0/10 (0–1/10) the day after surgery and 1 week after surgery, respectively. Univariate regression analysis of the total dose in successful cases provided the following formula: 1.3 + 0.00025 × volume (mm3) (mg). Polidocanol sclerotherapy is an effective treatment method for oral VM.
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20
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Abstract
INTRODUCTION Appropriate treatment of scalp arteriovenous malformations (SAVMs) remains largely unclear given the rarity of reported cases. This single-institution case series presents consecutive patients with extracranial SAVMs and long-term follow up.The primary aim of this study was to review treatment decisions, evaluate clinical outcomes, and compare our experience to available literature in order to better understand SAVMs and improve future outcomes. MATERIALS AND METHODS A retrospective review of consecutive patients with extracranial SAVMs between January 2015 and December 2019 was performed. Treatment factors of interest included embolization method, embolic agents, and decision to proceed with surgical resection. Relevant clinical outcomes included recurrence rates, cure rates, and complications. RESULTS Seven patients were included in the present series. Satisfactory outcomes were ultimately achieved for all 7 patients using embolization with or without combined surgical resection. Embolizations performed in combination with resection were curative in 4 of 4 cases (100%). Embolizations performed without resection were curative in 0 of 4 cases (0%), satisfactory in 2 of 4 cases (50%), and unsatisfactory in 2 of 4 cases (50%). DISCUSSION All SAVM patients in this series were treated satisfactorily using embolization with or without operative resection. This study strongly suggests that embolization combined with surgical resection during the same admission yields the best treatment outcomes for SAVMs, specifically demonstrating lower rates of recurrence and embolization-related complications. Decisions on whether or not to proceed with resection should be made by the interventional radiologist, the plastic surgeon, and the patient together.
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21
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Anh TT, Nguyen QL, Thi QM, Minh TP. Digital Subtraction Angiography-Guided Foam Sclerotherapy with Polidocanol for Treating Superficial Venous Malformation. Ann Vasc Dis 2021; 14:231-235. [PMID: 34707744 PMCID: PMC8474081 DOI: 10.3400/avd.oa.20-00164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aims to describe the angiographic imaging characteristics of superficial venous malformations and evaluate the treatment effectiveness of digital subtraction angiography (DSA)-guided foam sclerotherapy with polidocanol. Materials and Methods: This prospective study was conducted in 18 patients with venous malformation treated by DSA-guided sclerotherapy. Treatment outcomes were evaluated based on pain improvement and reduction in lesion size on magnetic resonance imaging (MRI) 6-months posttreatment. Results: A total 21 lesions and 46 sclerotherapy sessions were analyzed. MRI findings presented 8/21 lesions (38.1%) with excellent response, 9/21 (42.9%) with good response, and 3/21 (14.3%) with average response, while one patient (4.8%) showed no response. All patients experienced pain. A significant reduction (p<0.01) was observed in the pre- to posttreatment pain score (5.45 and 0.64, respectively). Over a follow-up period of 1–4 years, three out of four patients (75%) in the retrospective cohort experienced recurrence; one patient had an increased lesion size and pain score, while the other two patients only showed an increased lesion size. No severe complications were seen. Conclusion: DSA-guided sclerotherapy with polidocanol is a safe and effective procedure for reducing lesion size and pain in symptomatic patients with superficial venous malformations.
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Affiliation(s)
- Tuan Tran Anh
- Radiology Center, Bach Mai Hospital, Ha Noi, Vietnam.,Radiology Department, Hanoi Medical University, Ha Noi, Vietnam
| | - Quyen Le Nguyen
- Department of Thoracic, Vascular and Neurology, Trung Vuong Hospital, Ho Chi Minh City, Vietnam
| | - Quynh Mai Thi
- Radiology Department, Hanoi Medical University, Ha Noi, Vietnam
| | - Thong Pham Minh
- Radiology Center, Bach Mai Hospital, Ha Noi, Vietnam.,Radiology Department, Hanoi Medical University, Ha Noi, Vietnam
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22
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PTEN Hamartoma Tumor Syndrome/Cowden Syndrome: Genomics, Oncogenesis, and Imaging Review for Associated Lesions and Malignancy. Cancers (Basel) 2021; 13:cancers13133120. [PMID: 34206559 PMCID: PMC8268822 DOI: 10.3390/cancers13133120] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary In this manuscript, we present the associated imaging findings and imaging screening recommendations. Knowledge of the types of cancers commonly seen in Cowden syndrome and their imaging findings can aid in early tumor recognition during cancer screening to help ensure near-normal life spans in Cowden syndrome patients. Abstract PTEN hamartoma tumor syndrome/Cowden syndrome (CS) is a rare autosomal dominant syndrome containing a germline PTEN mutation that leads to the development of multisystem hamartomas and oncogenesis. Benign tumors such as Lhermitte–Duclos disease and malignant tumors involving the breast, thyroid, kidneys, and uterus are seen in CS. Radiologists have an integral role in the comanagement of CS patients. We present the associated imaging findings and imaging screening recommendations. Knowledge of the types of cancers commonly seen in CS and their imaging findings can aid in early tumor recognition during cancer screening to help ensure near-normal life spans in CS patients.
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23
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Xia Z, Gu H, Yuan Y, Xiang S, Zhang Z, Tao X. Value of Dynamic Contrast-Enhanced (DCE) MRI in Predicting Response to Foam Sclerotherapy of Venous Malformations. J Magn Reson Imaging 2021; 54:1108-1116. [PMID: 33991357 DOI: 10.1002/jmri.27657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Preoperative imaging assessment of venous malformations (VMs) and prediction of foam sclerotherapy efficacy might be achievable by DCE-MRI but elaborate quantitive analysis was absent. PURPOSE To evaluate the value of DCE-MRI in predicting the effectiveness of foam sclerotherapy in VMs. STUDY TYPE Retrospective. POPULATION Fifty-five patients (M:F = 17:38; mean age ± SD, 15.4 ± 13.0 years) with VMs. FIELD STRENGTH/SEQUENCE Three Tesla MRI with 3D T1 -weighted volume interpolated body examination. ASSESSMENT Patients who underwent pretreatment DCE-MRI were divided into "effective" and "ineffective" groups according to the response to foam sclerotherapy. Clinical characteristics and morphologic features were assessed. The semiquantitative parameters, such as maximum intensity time ratio (MITR), enhancement ratio (ER), and Slope, were obtained from ROI and volume of interest (VOI). The quartile and mean values of these parameters were acquired from VOI, while mean values denoted as Mean# were acquired from ROI. Establishment of two predictive models was based on ROI and VOI respectively. Model 1 was based on morphologic parameters and ROI semiquantitative parameters, while model 2 was based on morphologic parameters and VOI semiquantitative parameters. STATISTICAL ANALYSIS Mann-Whitney U-test, Cohen's kappa, multivariate logistic regression analysis (backward stepwise), and ROC analyses. RESULTS The lesion classification, presence of phlebolith, semiquantitative parameters of VOI (quartile and mean of MITR), and semiquantitative parameters of ROI (Slopemean # , MITRmean # ) were significantly different between two groups. Lesion classification (P = 0.002) and MITRmean# (P = 0.027) were independent predictors for poor efficacy in model 1 as determined by multivariate binary logistic regression analysis. For model 2, lesion classification (P = 0.006) and MITR25 (P = 0.001) were independent predictors. The predictive model based on VOI (AUC = 0.961) performed better than that based on ROI (AUC = 0.909) in predicting therapeutic response. DATA CONCLUSION DCE-MRI is promising in predicting the response to foam sclerotherapy for VMs. The whole lesion VOI-based model showed better performance and could instruct surgical approach in the future. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 4.
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Affiliation(s)
- Zhipeng Xia
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Hao Gu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Ying Yuan
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Shiyu Xiang
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Zimin Zhang
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Xiaofeng Tao
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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24
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Abu Ata N, Meyers AB, Merrow AC. Imaging of Vascular Anomalies in the Pediatric Musculoskeletal System. Semin Roentgenol 2021; 56:288-306. [PMID: 34281681 DOI: 10.1053/j.ro.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Nadeen Abu Ata
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Arthur B Meyers
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Arnold C Merrow
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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25
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Goyal A, Smita M, Jana M. Multiple giant venous malformations. J Vasc Surg Venous Lymphat Disord 2021; 9:508-509. [PMID: 33602459 DOI: 10.1016/j.jvsv.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/14/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Ankur Goyal
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Madhu Smita
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Manisha Jana
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
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26
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England RW, Motaghi M, Kohler B, Hemmingson TE, Wu AW, Weiss CR. Development and Preliminary Validation of the Patient-Reported Outcome Measure for Vascular Malformation Questionnaire: A Prospective Cohort Study. J Vasc Interv Radiol 2021; 32:683-690.e4. [PMID: 33678569 DOI: 10.1016/j.jvir.2021.01.263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/18/2020] [Accepted: 01/13/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To develop and validate the Patient-Reported Outcome Measure for Vascular Malformation (PROVAM) questionnaire to assess the health-related quality of life in patients with vascular malformations. MATERIALS AND METHODS We developed and validated PROVAM using a mixed methods design during a prospective clinical trial at a vascular anomalies clinic. From July 2019 to February 2020, 108 consecutive patients completed 130 questionnaires. The 30-item instrument assessed the domains of pain, emotional/social well-being, functional impact, and treatment satisfaction. Two additional items assessed ease of understanding and relevance. The primary outcomes of instrument reliability and validity were evaluated across several indices. The secondary outcome of responsiveness evaluated total score changes for patients who completed questionnaires both before and after treatment. RESULTS Instrument reliability, as measured by Cronbach alpha, was ≥0.79 for pain, emotional/social well-being, and functional impact domains. Primary domain structure was confirmed by factor analysis (P <. 001) and convergent construct validity for all but 1 Likert scale item. In the subgroup analysis of 13 participants who completed PROVAM before and after treatment, instrument responsiveness, as measured by the total score, showed a significant decrease (median, -10 points; interquartile range [IQR], -3 to -16; P = .04). Participants found the questions easy to understand (median, 5 points; IQR, 4-5 on a 5-point scale) and relevant (median score, 4; IQR, 3-5). CONCLUSIONS Preliminary data support the reliability and validity of PROVAM in measuring the health-related quality of life in patients with vascular malformations.
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Affiliation(s)
- Ryan W England
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Interventional Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Mina Motaghi
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Interventional Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Beatriz Kohler
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Interventional Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Thomas E Hemmingson
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Interventional Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Albert W Wu
- Center for Health Services and Outcomes Research, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Clifford R Weiss
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Interventional Radiology, The Johns Hopkins Hospital, Baltimore, Maryland.
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27
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Abstract
BACKGROUND Intramuscular venous malformations, often erroneously called "intramuscular hemangiomas," present to pediatric orthopaedic surgeons either as a differential diagnosis of tumor or as a cause of muscle pain. Treatment options include injection sclerotherapy or surgery. There is some literature to indicate that sclerotherapy can reduce pain, but little evidence on the effectiveness of surgery. The primary aim of this study was to evaluate the efficacy of surgical resection for intramuscular venous malformations, with a secondary aim to evaluate the natural history and presentation of intramuscular venous malformations to improve clinician understanding of this condition. METHODS A retrospective chart analysis was performed of cases identified from a vascular anomalies database from January 2004 and December 2018. Primary outcome was change in preoperative and postoperative pain. Natural history of the lesion was assessed, including age when the lesion was first noticed, when it became painful, and when it required treatment. RESULTS Fifty-four cases were identified in the study period of which 40 underwent surgery. Pain improved in 36 of 39 patients (92.3%) who had pain before surgery and 29 (74.4%) were pain free after surgery. All 13 patients who required whole muscle excision to resect the lesion experienced an improvement in pain and 10 (76.9%) were pain free. A history of previous intervention, with surgery or sclerotherapy showed a trend towards less successful surgical outcomes. Patients presented across a wide age range from infancy to adulthood, but the most common presentation was pain with exercise between 9 and 16 years of age, with presence of a mass in about half of cases. CONCLUSIONS Surgery, when performed by a surgeon with appropriate experience, is an effective first-line treatment for painful intramuscular venous malformations, offering pain relief in the majority of cases. Magnetic resonance imaging and ultrasound are diagnostic in most cases. The majority of lesions are resectable, meaning they can be removed with a margin leaving a functional limb. Sometimes resection of a whole muscle is required. LEVEL OF EVIDENCE Level IV-case series.
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28
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Ultrasound Evaluation of Pediatric Slow-Flow Vascular Malformations: Practical Diagnostic Reporting to Guide Interventional Management. AJR Am J Roentgenol 2020; 216:494-506. [PMID: 33356433 DOI: 10.2214/ajr.20.23338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE. This article reviews the ultrasound characteristics of pediatric slow-flow vascular malformations and underscores findings that significantly impact diagnosis and treatment. Key imaging features are discussed including lesion size, malformation location, morphology, and mimics. CONCLUSION. Ultrasound findings affect the management of slow-flow vascular malformations and should be emphasized in lesion diagnosis. Superficial, focal lesions with well-defined margins are ideal for ultrasound evaluation.
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29
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Venous malformation of the foot: Spontaneous regression postpartum on MRI. Radiol Case Rep 2020; 16:62-65. [PMID: 33193930 PMCID: PMC7642758 DOI: 10.1016/j.radcr.2020.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/20/2020] [Indexed: 11/29/2022] Open
Abstract
Venous malformations (VMs) are present at birth, grow proportionally during childhood, and usually do not regress. We report the imaging appearance of a VM of the foot found during pregnancy, which regressed spontaneously postpartum. A 35-year-old, 8-month-pregnant woman presented with a 6-month history of painful swelling of the left foot. MRI demonstrated a well-defined, intricate-shaped mass measuring 38 × 36 × 28 mm between the muscles and tendons of the third, fourth, and fifth toes with subcutaneous extension. Dynamic CT taken a month after delivery revealed gradual enhancement of the lesion. Gray-scale ultrasonography (US) showed a heterogenic hypoechoic mass containing thrombi with venous waveforms on Doppler US. A second MRI obtained 15 months after delivery showed a remarkable reduction of the lesion size (16 × 20 × 15 mm). Symptomatic VMs found during pregnancy can be observed conservatively without treatment.
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30
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Liberale C, Rozell-Shannon L, Moneghini L, Nocini R, Tombris S, Colletti G. Stop Calling Me Cavernous Hemangioma! A Literature Review on Misdiagnosed Bony Vascular Anomalies. J INVEST SURG 2020; 35:141-150. [DOI: 10.1080/08941939.2020.1824041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | - Riccardo Nocini
- Department of Otorhinolaryngology, University Hospital of Verona, Verona, Italy
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31
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Abstract
The head and neck are the most common site of involvement for vascular tumors and malformations, with more than half of all vascular anomalies seen in this region. Lesions in this location can cause significant disfigurement and can be associated with airway obstruction, impairment in vision or hearing, swallowing disorders and hemorrhage. Accurate diagnosis is critical in determining treatment, and interdisciplinary care is essential for optimal management. We review clinical and imaging features that are key to establishing the correct diagnosis, and review treatment modalities, with emphasis on interventional and surgical procedures.
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Affiliation(s)
- Abdullah Alsuwailem
- Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, USA
| | - Charles M Myer
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Gulraiz Chaudry
- Division of Vascular and Interventional Radiology, Boston Children's Hospital and Harvard Medical School, USA.
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MR imaging of venous malformations: sciatic nerve infiltration patterns and involved muscle groups. Sci Rep 2020; 10:14618. [PMID: 32884092 PMCID: PMC7471964 DOI: 10.1038/s41598-020-71595-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 08/17/2020] [Indexed: 12/20/2022] Open
Abstract
The aim of this retrospective cross-sectional study was to provide an MRI-based examination framework of venous malformations (VMs) infiltrating the sciatic nerve and determine the frequency of nerve infiltration patterns and muscle involvement in correlation to the patients’ quality of life. Pelvic and lower limb MR images of 378 patients with vascular malformations were examined retrospectively. Pain levels and restriction of motion were evaluated with a questionnaire. Cross-sectional areas of affected nerves were compared at standardized anatomical landmarks. Intraneural infiltration patterns and involvement of muscles surrounding the sciatic nerve were documented. Sciatic nerve infiltration occurred in 23/299 patients (7.7%) with VM. In all cases (23/23; 100%), gluteal or hamstring muscles surrounding the nerve were affected by the VM. Infiltrated nerves were enlarged and showed signal alterations (T2-hyperintensity) compared to the unaffected side. Enlarged nerve cross-sectional areas were associated with elevated pain levels. Three nerve infiltration patterns were observed: subepineurial (12/23; 52.2%), subparaneurial (6/23; 26.1%) and combined (5/23; 21.7%) infiltration. This study provides a clinically relevant assessment for sciatic nerve infiltration patterns and muscle involvement of VMs, while suggesting that VMs in gluteal and hamstring muscles require closer investigation of the sciatic nerve by the radiologist.
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Abstract
BACKGROUND Venolymphatic malformations are rare benign vascular lesions of the head and neck. Sclerotherapy has become the first-line therapy of these lesions with bleomycin being a sclerosing agent commonly used. PURPOSE To perform a systematic review of the published literature to synthesize evidence on the safety and efficacy of bleomycin for the treatment of head and neck venolymphatic malformations. DATA SOURCES A systematic review of the literature (January 1995-May 2019) was performed in PubMed, Embase, and Cochrane Library databases to identify studies on sclerotherapy of venolymphatic malformations of the head and neck. STUDY SELECTION A total of 32 studies with participants met the inclusion criteria among which 1121 patients were included in the systematic review. DATA ANALYSIS Two reviewers independently screened and extracted data and assessed the risk of bias. The primary outcome was the subjective or objective reduction of lesion size as well as minor and major complications. DATA SYNTHESIS The bleomycin/pingyangmycin sclerotherapy achieved subjective or objective lesion size reduction in 96.3% (95% CI 94.1%-98.5%) of patients. Minor complications were observed in 16.2% and major complications in 1.1%. CONCLUSION Bleomycin is a highly effective treatment of venolymphatic malformations of the head and neck with a low rate of major adverse events. This study represents an update on the "available" evidence, but only low-to-moderate quality studies were available. LIMITATIONS This study reviewed 32 studies performed in different parts of the world, but there was heterogeneity of the study designs and interventions.
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Bagga B, Goyal A, Das A, Bhalla AS, Kandasamy D, Singhal M, Kairo A. Clinicoradiologic predictors of sclerotherapy response in low-flow vascular malformations. J Vasc Surg Venous Lymphat Disord 2020; 9:209-219.e2. [PMID: 32653406 DOI: 10.1016/j.jvsv.2020.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/19/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the clinical effectiveness of sclerotherapy agents in low-flow vascular malformations (LFVM) and identify clinical/imaging features to predict response. METHODS A retrospective analysis of hospital records of symptomatic LFVM patients who underwent phlebosclerotherapy from January 2015 to April 2018 was done. Patients were subdivided into venous malformations (VM) and lymphatic malformations (LM). Out of 246 cases, 223 patients (132 males, 91 females; age range, 2-52 years) had VM and 23 (13 males, 10 females; age range, 3 months to 45 years) had LM. The clinical response was graded as excellent (>60%), good (30%-60%), and poor (<30%). More than 30% was considered as acceptable response. The χ2 test was performed for correlation between clinical response and clinical, sonographic, magnetic resonance imaging, phlebographic parameters followed by multilinear regression. RESULTS Cavitary (43%) and spongy (37.7%) were the most common phlebographic patterns seen among VM and a cavitary pattern (87%) was most frequent in LM. Sodium tetradecyl sulphate and bleomycin were most commonly used sclerosants in VM and LM, respectively. The mean number of sessions was 4.35 (range, 1-23) in VM and 2.64 (range, 2-7) in LM. Among VM, 114 patients (51.1%) had excellent response to treatment (>60%) and 75.8% patients had an acceptable response (>30%). All patients with LM had an acceptable response (excellent response in 86.9%). Clinical disfigurement, discoloration, diffuse involvement, dysplastic venous morphology on phlebogram, and late and indirect draining vein correlated with poor response to sclerotherapy in VM (P = .003, P = .036, P = .007, P = .008, P = .003, and P = .035, respectively). Cystic components on ultrasound examination and direct draining vein were seen more often in excellent responders (P = .004 and P = .007) in addition to absence of disfigurement, discoloration, and diffuse involvement (P = .032, P = .003, and P = .002). Mod els comprising clinical disfigurement, dysplastic veins, and late draining vein had the greatest predictive value for poor response (R2 = 0.256). Also, the best model for predicting excellent response comprised presence of direct draining vein and absence of skin discoloration (R2 = 0.109). Eleven instances of minor complications occurred among a total of 1032 sessions, seven with sodium tetradecyl sulphate and four with polidocanol. CONCLUSIONS Acceptable response to sclerotherapy was achieved in majority of LFVM with extremely low complication rates. Clinicoradiologic features, especially phlebographic findings, correlated with response to sclerotherapy.
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Affiliation(s)
- Barun Bagga
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
| | - Abanti Das
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | | | - Maneesh Singhal
- Department of Plastic Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Kairo
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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El Khoury M, Bejjani J, Trop I, Labelle M, Mesurolle B. Venous malformation of the pectoral muscle depicted on mammogram. Clin Imaging 2020; 63:57-59. [DOI: 10.1016/j.clinimag.2020.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/18/2020] [Accepted: 02/26/2020] [Indexed: 11/24/2022]
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Abstract
Recent advances in imaging have allowed a better understanding of imaging features and classification of vascular anomalies. This article focuses on imaging of vascular malformations; describes the updated classification system and clinical and imaging characteristics of the different subtypes; and discusses the associated syndromes, differential diagnosis, and available treatment options, including the role of imaging in management.
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Zeevi I, Chaushu G, Alterman M, Chaushu L. Sclerotherapy of Vascular Malformations in the Oral Cavity-Minimizing Postoperative Morbidity. MEDICINA-LITHUANIA 2020; 56:medicina56050254. [PMID: 32456057 PMCID: PMC7279465 DOI: 10.3390/medicina56050254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 11/16/2022]
Abstract
Vascular malformations (VMs) are a wide vascular or lymphatic group of lesions common on the head and neck. The objective of this study was to assess the efficacy and morbidity of sclerotherapy for the treatment of VMs in the oral and perioral area. Special attention was given to factors that may contribute to minimizing postoperative morbidity. Data from 25 patients (32 lesions) with oral VMs submitted to sclerotherapy with monoethanolamine oleate (EAO) were included. A structured form was used to collect data. An arbitrary score was determined to evaluate postoperative morbidity. Each of the following signs or symptoms received one point: pain, swelling, hematoma, ulceration, erythema, transient numbness, and transient itching. Pain and swelling were further divided into mild to moderate (1 point) and severe (2 points). Theoretically, the score was in the range of 0–9. Calculated scores ranged 0–4. The patients were further divided into two groups with scores of 0–1 denoting minimal morbidity (MIN) and 2–4 denoting significant morbidity (SIG). The number of lesions in each morbidity-score group were comparable (MIN 17and SIG 15). There were no statistically significant differences between the groups regarding age, number of applications, or average injection volume per mm lesion. Statistically significant differences were noted regarding gender (p = 0.05), lesion diameter (p = 0.030), total volume of first (p = 0.007) and second application (p = 0.05), and total injected volume (p = 0.03). Factors contributing to the risk for significant morbidity included being male, lesion diameter > 5 mm, volume > 0.3 mL per application, and total injected volume > 0.3 mL. A waiting time of 12 weeks prior to additional EAO application was required in 12 out of 29 lesions for clinical observation of complete regression. It was concluded that sclerotherapy with EAO as monotherapy is easy to apply, safe, and effective within a small number of sessions. Application of <0.3 mL EAO per session, and a waiting time of 12 weeks prior to the second application, would significantly minimize morbidity.
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Affiliation(s)
- Itai Zeevi
- Department of Oral and Maxillofacial Surgery, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; (I.Z.); (M.A.)
| | - Gavriel Chaushu
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tel Aviv University, Tel-Aviv 69978, Israel;
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Campus Beilinson, Petah Tiqwa 49100, Israel
| | - Michael Alterman
- Department of Oral and Maxillofacial Surgery, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel; (I.Z.); (M.A.)
| | - Liat Chaushu
- Department of Periodontology and Implant Dentistry, School of Dental Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
- Correspondence:
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Restrepo R, Pevsner R, Pelaez L, Plut D, Lee EY. Three Distinct Vascular Anomalies Involving Skeletal Muscle: Simplifying the Approach for the General Radiologist. Radiol Clin North Am 2020; 58:603-618. [PMID: 32276706 DOI: 10.1016/j.rcl.2020.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Venous malformations and hemangiomas of the skeletal muscle are separate entities with different clinical presentation, histology, and imaging findings. Recent advances in the field of vascular anomalies and current efforts in the unification of terminology by the International Society for the Study of Vascular Anomalies are pivotal in understanding and differentiating intramuscular venous malformations and intramuscular capillary-type hemangioma. Fibroadipose vascular anomaly is another recently defined vascular anomaly affecting the skeletal muscle, with a distinct clinical presentation, histology, and imaging appearance. These 3 distinct vascular anomalies are reviewed and their histologic features, clinical presentation, imaging appearance, and treatment are discussed.
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Affiliation(s)
- Ricardo Restrepo
- Department of Pediatric Radiology, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL 33155, USA
| | - Rachel Pevsner
- Department of Pediatric Radiology, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL 33155, USA
| | - Liset Pelaez
- Department of Pathology, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL 33155, USA
| | - Domen Plut
- Department of Pediatric Radiology, Clinical Radiology Institute, University Medical Centre, Ljubljana, Zaloska cesta 7, Ljubljana 1000, Slovenia
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Spectrum of Imaging Manifestations of Vascular Malformations and Tumors Beyond Childhood: What General Radiologists Need to Know. Radiol Clin North Am 2020; 58:583-601. [PMID: 32276705 DOI: 10.1016/j.rcl.2020.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Vascular anomalies encompass a collection of diagnoses that differ greatly in terms of clinical presentation, natural history, imaging findings, and management. The purpose of this article is to review diagnostic imaging findings of vascular malformations and vascular tumors, excluding the central nervous system, that occur beyond childhood. A widely accepted classification system created by the International Society for the Study of Vascular Anomalies provides a framework for this review, focusing on the entities most likely to be encountered by general radiologists, although several rare but clinically important entities are also reviewed.
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Hou F, Chen J, Xia M, Ding K, Zeng Q, Liu W. Percutaneous sclerotherapy with polidocanol under the guidance of ultrasound for venous malformations in children - A retrospective cohort study from a single tertiary medical center. Medicine (Baltimore) 2020; 99:e18839. [PMID: 32118707 PMCID: PMC7478829 DOI: 10.1097/md.0000000000018839] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study reports our experience, the therapeutic outcomes and complications of percutaneous sclerotherapy (PS) with polidocanol to treat venous malformations (VMs) in children.A retrospective analysis was conducted of pediatric patients with VMs who underwent PS using polidocanol under continuous ultrasound (US) guidance between January 2015 and January 2018 at our department. Medical records were reviewed to record demographic information, lesion characteristics, treatment sessions, therapeutic outcomes and complications. χ analysis was employed to evaluate the effects of these characteristics on outcomes.Hundred treatment sessions were performed for lesions in 47 patients. The mean age of the patients was 4.1 ± 3.6 years (mean ± SD). The female to male ratio was almost 2:1 (female 32, male 15). The location of the VMs included the head and neck in 16 cases (34.0%), upper extremity in 11 cases (23.4%), lower extremity in 10 cases (21.3%), and trunk and perineum in 10 cases (21.3%). The majority of the lesions were focal in 36 cases (76.6%), while 11 (23.4%) were diffuse. Seventeen patients (36.2%) underwent single PS session, 14 patients (29.8%) underwent 2 sessions, 10 patients (21.3%) underwent 3 sessions and 6 patients (12.7%) underwent ≧4 sessions. The mean PS session per patient was 2.1 ± 1.1. The mean follow-up duration was 11.4 ± 7.6 months. After the last PS session, 8 patients (17.0%) had excellent outcomes, 27 (57.4%) had good outcomes, 10 (21.3%) had fair outcomes, and 2 (4.3%) had poor outcomes. Focal lesions were more likely to have good or excellent outcomes than diffuse lesions (χ = 4.522, P = .033). No other lesion characteristic significantly affected the outcomes (good or excellent outcomes), including lesion location (χ = 2.011, P = .570) or lesion size (χ = 1.045, P = .307). After the PS procedure, temporary local swelling occurred in 81 sessions (81.0%), local pain occurred in 15 sessions (15.0%), fever occurred in 27 (27.0%) sessions, and transient local numbness occurred in four sessions (4.0%).PS with polidocanol under the guidance of US appears to be safe and effective for the treatment of VMs in children, especially for focal lesions.
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Affiliation(s)
- Fang Hou
- Department of Pediatric Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital
- Department of Pediatric Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China
| | - Jidong Chen
- Department of Ultrasound, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Meng Xia
- Department of Pediatric Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital
| | - Ke Ding
- Department of Pediatric Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital
- Department of Pediatric Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China
| | - Qiang Zeng
- Department of Pediatric Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital
| | - Wenying Liu
- Department of Pediatric Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital
- Department of Pediatric Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China
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Badarudeen B, Roy N, Pillai H. Management of a curious case of a large recurrent truncal vascular anomaly in a young adult. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.4103/ijves.ijves_4_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Dhagat P, Jain M, Farooq A. MRI evaluation of soft tissue vascular malformations. Indian J Radiol Imaging 2020; 30:184-189. [PMID: 33100687 PMCID: PMC7546293 DOI: 10.4103/ijri.ijri_439_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/24/2020] [Accepted: 04/09/2020] [Indexed: 11/22/2022] Open
Abstract
Background: Soft tissue vascular malformations are not uncommonly encountered in clinical practice and are often mistaken for other pathologies. Vascular anomalies are divided into vascular tumors and malformations. Vascular malformations progressively increase in size with increasing age and are classified into low-flow (venous, lymphatic, veno-lymphatic, capillary and capillary venous) and high-flow malformations (arteriovenous malformations (AVM) and arteriovenous fistula (AVF)) depending on the presence or absence of arterial flow. Aim: Aim of this study is to evaluate the Magnetic resonance imaging (MRI) features of the soft tissue vascular malformations and to classify the lesions depending on flow pattern. Materials and Methods: A total of 52 patients of soft tissue vascular malformations were included in this study over a period of 3 years. All patients underwent detailed clinical examination and dynamic post contrast MRI evaluation. Doppler and ultrasound were done as an adjunct. Results: There were 31 females and 21 male patients with age ranging from 9 to 34 years. In total 33 venous, 11 lymphatic, 8 veno-lymphatic malformations were seen. No case of high-flow malformation was seen. Majority of the lesions involved the head and neck region and the extremities. Fat saturated T2WI, STIR, and 3D dynamic post contrast sequences were found to be the most useful MRI sequences. Conclusion: MRI is the modality of choice for evaluating the soft tissue vascular malformations. It depicts the extent of the lesion, classifies the lesions into low or high flow and helps in treatment planning.
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Manzano BR, Premoli AM, Santaella NG, Ikuta CRS, Rubira CMF, Santos PSDS. Sclerotherapy as an esthetic indication in oral vascular malformations: a case series. An Bras Dermatol 2019; 94:521-526. [PMID: 31777351 PMCID: PMC6857549 DOI: 10.1016/j.abd.2019.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 06/26/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The use of monoethanolamine oleate 5% is effective for the treatment of vascular malformations with low blood flow. OBJECTIVES To report a case series of vascular malformations in the mouth and oral cavity treated with monoethanolamine oleate 5%. METHODS A retrospective descriptive study was performed in electronic patient charts covering seven years. Patient demographics, diagnostic resources, lesion site, size, and number of applications of monoethanolamine oleate 5% were collected. RESULTS A total of 21 vascular malformations were recorded, located mostly on the lower lip (52.3%) and resolved in a single application in 14 patients. The authors found 19 patients treated with sclerotherapy. Thirteen were women and six were men, with a mean age of 61 years. STUDY LIMITATION Small sample size. CONCLUSIONS Sclerotherapy is an effective treatment for vascular malformations of the lips and oral cavity, with resolution after only one or two applications (n=16).
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Affiliation(s)
- Brena Rodrigues Manzano
- Department of Surgery, Stomatology, Pathology, and Radiology, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brazil.
| | - Aloizio Maciel Premoli
- Department of Surgery, Stomatology, Pathology, and Radiology, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brazil
| | - Natalia Garcia Santaella
- Department of Surgery, Stomatology, Pathology, and Radiology, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brazil
| | - Carla Renata Sanomiya Ikuta
- Department of Surgery, Stomatology, Pathology, and Radiology, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brazil
| | - Cássia Maria Fisher Rubira
- Department of Surgery, Stomatology, Pathology, and Radiology, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brazil
| | - Paulo Sérgio da Silva Santos
- Department of Surgery, Stomatology, Pathology, and Radiology, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brazil
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Legiehn GM. Sclerotherapy with Adjunctive Stasis of Efflux (STASE) in Venous Malformations: Techniques and Strategies. Tech Vasc Interv Radiol 2019; 22:100630. [PMID: 31864535 DOI: 10.1016/j.tvir.2019.100630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Venous malformations are very commonly encountered in interventional radiologic practice. Indications for therapy are clearly defined based on the lesion's impact on patient's quality of life. Screening laboratory coagulation studies in patients with historical or lesion morphologic risk factors often reveal abnormal coagulation parameters consistent with localized intravascular coagulation or more severe coagulopathic states. These may require chronic or periprocedural medical management to avoid potentially life-threatening disseminated intravascular coagulation or other thromboembolic phenomena. Once a multidisciplinary decision to treat a venous malformation is made, one must decide between percutaneous and/or surgical techniques. Sclerotherapy with adjunctive stasis of efflux (STASE) techniques have become the mainstay of therapy for most venous malformations as they are well-tolerated and effective. STASE techniques work primarily by (i) the administration of sclerosant(s) exerting an inhibitory and/or endotheliocidal effect on venous malformation endothelium leading to thrombosis, involution, and fibrosis, and secondarily via adjunctive outflow occlusion using any combination of local compression, balloons, gelatin, coils, laser, radiofrequency, or adhesives to improve sclerosant penetration and dwell-time in the lesion. Adhesives alone can fill the lesion to facilitate surgical resection in some cases. Common sclerosants in modern practice include sodium tetradecyl sulfate, bleomycin, polidocanol, ethanol, and hypertonic saline. Most agents can be given directly in unmodified or "neat" form or can be mixed with a gas to form a sclerofoam or embolic such as gelatin to form a sclerogel. Choice and method of sclerosant delivery in each patient is based on the intraluminal lesion volume, architecture, vital structure proximity, agent toxicity, viscosity, and level of experience of the interventional radiologist with that particular agent. Multi-session STASE therapy usually reduces symptoms of chronic pain or mass with low risk of known complications of skin or nerve impairment, compartment syndrome, hemoglobinuria, deep venous thrombosis, or pulmonary phenomena.
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Affiliation(s)
- Gerald M Legiehn
- Division of Interventional Radiology, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
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Abstract
Ongoing discovery regarding the origin and treatment of vascular anomalies requires standardized nomenclature which itself must undergo iterative updating. This article introduces the 2018 International Society for the Study of Vascular Anomalies (ISSVA) classification, emphasizing the biologic basis of vascular anomalies, summarizing the key features of commonly encountered entities, and serving as a foundation for subsequent articles presented herein. Vascular tumors are discussed to highlight their distinction from vascular malformations which will receive greater attention with respect to management and technical considerations within the issue.
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Affiliation(s)
- Eric J Monroe
- Department of Radiology, Seattle Children's Hospital, Seattle, WA; Department of Radiology, University of Washington, Seattle, WA.
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Sindel A, Sayan A, Özgür Ö, Sindel T, Ilankovan V. Percutaneous treatment of orofacial vascular malformations. Br J Oral Maxillofac Surg 2019; 56:206-211. [PMID: 29422307 DOI: 10.1016/j.bjoms.2018.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 01/18/2018] [Indexed: 11/17/2022]
Abstract
The aim of this study was to evaluate the efficacy of fluoroscopy-guided percutaneous injection of bleomycin as the primary treatment for low-flow vascular malformations. A total of 34 patients (mean (range) age 24 (8-51) years) with orofacial vascular lesions were treated in the Department of Interventional Radiology and Maxillofacial Surgery. There were 20 low-flow venous malformations, 11 lymphatic malformations, and three of mixed type. All patients were treated by fluoroscopy-guided percutaneous injection of a mixture of bleomycin (mean (range) 15 (5-15)mg) and a radio-opaque agent (Ultravist® (iopromide), Bayer)/session. The number of sessions ranged from one to six. The clinical response was complete in 21 patients, obvious in nine, and of clinical benefit in four. Patients were reviewed within the first week, third week, and at three-month periods until 24 months. There were no serious complications such as pulmonary fibrosis. Fluoroscopy-guided intralesional injection of bleomycin should be considered as the first-line treatment for lymphatic malformations because it is effective and reliable with few complications.
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Affiliation(s)
- A Sindel
- Department of Oral and Maxillofacial Surgery, Akdeniz University, Antalya, Turkey
| | - A Sayan
- Department of Oral and Maxillofacial surgery, Poole Hospital NHS Foundation Trust.
| | - Ö Özgür
- Department of Radiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - T Sindel
- Department of Radiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - V Ilankovan
- Department of Oral and Maxillofacial surgery, Poole Hospital NHS Foundation Trust
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Flow Pattern Classification in Lymphatic Malformations by Indocyanine Green Lymphography. Plast Reconstr Surg 2019; 143:558e-564e. [DOI: 10.1097/prs.0000000000005362] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Flors L, Hagspiel K, Park A, Norton P, Leiva-Salinas C. Vascular malformations and tumors. Part 2: Low-flow lesions. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2018.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ahmad S. Efficacy of Percutaneous Sclerotherapy in Low Flow Venous Malformations - A Single Center Series. Neurointervention 2019; 14:53-60. [PMID: 30827065 PMCID: PMC6433194 DOI: 10.5469/neuroint.2019.00024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/25/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose We analyzed results of percutaneous sclerotherapy for venous malformations (VMs) in head, neck and extremities. Materials and Methods Thirty-five patients with head and neck and extremities VM treated by sclerotherapy with bleomycin and sodium tetradecyl sulphate (STS) were retrospectively reviewed. A pre-treatment magnetic resonance imaging was done for all patients to diagnose the lesion. Each lesion received 1 to 11 sessions (average, 2.7; standard deviation [SD], 2.03). We evaluated percentage reduction in swelling size and a Likert scale review of subjective feelings of the patients. Results Sixteen had a complete obliteration; by sclerotherapy alone (n=13) and surgery after a 75% reduction (n=3). Ten patients had a significant reduction up to 75% and three patients by 50%. Four had a minimal decrease with reduction of 25% or less. Follow-up duration of the patients varied from a minimum of 6 months up to 3 years (average, 15.7 months; SD, 7.8 months). Of all patients, three refused further treatment and were lost to follow-up, while another two were referred to a dermatologist. Thirteen patients reported feeling excellent after the sessions. Eight patients claimed to feel slightly better compared to before the sessions started. Only three patients complained of feeling the same before and after the sessions. None of the patients still in follow-up have reported a recurrence of a lesion thus far. Conclusion Sclerotherapy using bleomycin and STS as sclerosants is a safe and effective primary treatment for VMs in the head and neck as well as in extremities.
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Affiliation(s)
- Saima Ahmad
- Department of Neuroradiology, Lahore General Hospital, Lahore, Pakistan
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Peripheral vascular malformations - modern imaging. Pol J Radiol 2019; 83:e253-e259. [PMID: 30627244 PMCID: PMC6323586 DOI: 10.5114/pjr.2018.75724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/16/2018] [Indexed: 12/03/2022] Open
Abstract
Currently the major aim in peripheral vascular malformation diagnosis, crucial for subsequent management and treatment, is to identify its haemodynamic characteristics. Other significant features that should be specified by a radiologist are the exact location of the anomaly, its size, and its morphology. Until recently the diagnostic methods available for comprehensive evaluation of malformations have been rather limited. Moreover, they were often associated with the necessity of exposing the patient to X-ray radiation and with invasive procedures, as for example in angiography. The development of imaging techniques used in the diagnosis of vascular abnormalities in recent years, especially magnetic resonance imaging, has contributed to improved diagnostic value of the tests. In this article we review the currently available imaging modalities with particular consideration of magnetic resonance imaging and its capability to distinguish between high- and low-flow malformations.
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