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Hartman E, Balkin DM, See AP. A Review of the Current State and Future Directions for Management of Scalp and Facial Vascular Malformations. J Korean Neurosurg Soc 2024; 67:315-325. [PMID: 38720545 PMCID: PMC11079557 DOI: 10.3340/jkns.2024.0032] [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: 02/06/2024] [Revised: 04/06/2024] [Accepted: 04/16/2024] [Indexed: 05/12/2024] Open
Abstract
Vascular malformations are structural abnormalities that are thought to result from errors in vasculogenesis and angiogenesis during embryogenesis. Vascular malformations of the scalp present unique management challenges due to aesthetic and functional implications. This review examines the pathophysiology, clinical presentation, and management techniques for six common types of vascular malformations of the face and scalp : infantile hemangioma, capillary malformations, venous malformations, lymphatic malformations, arteriovenous malformations, and arteriovenous fistulas. These lesions range from common to rare, and have very different natural histories and management paradigms. There has been increasing understanding of the molecular pathways that are altered in association with these vascular lesions and these molecular targets may represent novel strategies of treating lesions that have historically been approached from a structural perspective only.
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Affiliation(s)
- Emma Hartman
- Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel M. Balkin
- Department of Plastic & Oral Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Alfred Pokmeng See
- Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
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2
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Zhu HT, Chen WG, Wang JJ, Guo JN, Zhang FM, Xu GQ, Chen HT. Endoscopic ultrasound-guided lauromacrogol injection for treatment of colorectal cavernous hemangioma: Two case reports. World J Gastrointest Surg 2024; 16:966-973. [PMID: 38577088 PMCID: PMC10989353 DOI: 10.4240/wjgs.v16.i3.966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/20/2024] [Accepted: 02/25/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Colorectal cavernous hemangioma is a rare vascular malformation resulting in recurrent lower gastrointestinal hemorrhage, and can be misinterpreted as colitis. Surgical resection is currently the mainstay of treatment, with an emphasis on sphincter preservation. CASE SUMMARY We present details of two young patients with a history of persistent hematochezia diagnosed with colorectal cavernous hemangioma by endoscopic ultrasound (EUS). Cavernous hemangioma was relieved by several EUS-guided lauromacrogol injections and the patients achieved favorable clinical prognosis. CONCLUSION Multiple sequential EUS-guided injections of lauromacrogol is a safe, effective, cost-efficient, and minimally invasive alternative for colorectal cavernous hemangioma.
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Affiliation(s)
- Hua-Tuo Zhu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Wen-Guo Chen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Jing-Jie Wang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Jia-Nan Guo
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Fen-Ming Zhang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Guo-Qiang Xu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Hong-Tan Chen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
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3
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Arleo TL, Swerdlin RF, Gill AE, Goudy SL, Meisel JA, Briones MA, Shah JH, Wright A, Hawkins CM. Baseline Quality of Life in Pediatric Patients With Low-flow Vascular Malformations. J Pediatr Hematol Oncol 2023; 45:e847-e856. [PMID: 37539995 DOI: 10.1097/mph.0000000000002740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/29/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE The aim of this study was to quantify and describe baseline patient and parent-proxy health-related quality of life scores in patients with low-flow vascular malformations at a single, tertiary-care vascular anomalies clinic. STUDY DESIGN This is a retrospective study of data collected on patients with low-flow vascular malformations between the ages of 2 to 25 who were seen at a single, tertiary-care center vascular anomalies clinic. A total of 266 patients are included in this study. RESULTS Patients with lymphatic malformations report decreased quality of life scores as compared with venous malformations in the emotional, psychological, school, and social domains. Patients with lower extremity malformation report decreased quality of life scores as compared with head/neck, trunk, upper extremity, and multifocal malformations; most notably in the physical domain. CONCLUSIONS Treatment of low-flow vascular malformations should aim to improve patient quality of life. The use of standardized health-related quality of life measures in this study quantifies baseline quality of life scores among patients with low-flow vascular malformations.
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Affiliation(s)
| | | | - Anne E Gill
- Children's Healthcare of Atlanta, Vascular Anomalies Clinic
- Department of Radiology and Imaging Sciences, Children's Healthcare of Atlanta, Emory University
| | - Steven L Goudy
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Children's Healthcare of Atlanta, Emory University
| | - Jonathan A Meisel
- Pediatric Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine
| | - Michael A Briones
- Children's Healthcare of Atlanta, Vascular Anomalies Clinic
- Division of Pediatric Hematology-Oncology, Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Emory University, Atlanta, GA
| | - Jay H Shah
- Children's Healthcare of Atlanta, Vascular Anomalies Clinic
- Department of Radiology and Imaging Sciences, Children's Healthcare of Atlanta, Emory University
| | - Allyson Wright
- Children's Healthcare of Atlanta, Vascular Anomalies Clinic
| | - Clifford Matthew Hawkins
- Children's Healthcare of Atlanta, Vascular Anomalies Clinic
- Department of Radiology and Imaging Sciences, Children's Healthcare of Atlanta, Emory University
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4
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Al-Hammad WE, Fujikura M, Hisatomi M, Okada S, Munhoz L, Kawazu T, Takeshita Y, Fujita M, Yanagi Y, Asaumi JI. An imaging‑based diagnostic approach to vascular anomalies of the oral and maxillofacial region. Oncol Lett 2023; 26:394. [PMID: 37600333 PMCID: PMC10433708 DOI: 10.3892/ol.2023.13980] [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: 03/17/2023] [Accepted: 06/28/2023] [Indexed: 08/22/2023] Open
Abstract
The accurate diagnosis of vascular anomalies (VAs) is considered a challenging endeavor. Misdiagnosis of VAs can lead clinicians in the wrong direction, such as the performance of an unnecessary biopsy or inappropriate surgical procedures, which can potentially lead to unforeseen consequences and increase the risk of patient injury. The purpose of the present study was to develop an approach for the diagnosis of VAs of the oral and maxillofacial region based on computed tomography (CT), magnetic resonance imaging (MRI) and dynamic contrast-enhanced MRI (DCE-MRI). In the present study, the CT and MR images of 87 VAs were examined, and the following imaging features were evaluated: Detectability of the lesion, the periphery of the lesion, the inner nature of the lesion, the density of the lesion on CT, the signal intensity of the lesion on MRI, the detectability of phleboliths and the shape of the lesion. A total of 29 lesions were further evaluated using the contrast index (CI) curves created from the DCE-MRI images. A diagnostic diagram, which is based on the imaging features of VAs and CI curve patterns, was subsequently extrapolated. The results obtained demonstrated that the VAs were detected more readily by MRI compared with CT, whereas the detectability of phleboliths was superior when using CT compared with MRI. VAs showed a propensity for homogeneous isodensity on CT, whereas, by contrast, they exhibited a propensity for heterogeneous hyperdensity on CE-CT. VAs also showed a propensity for homogeneous intermediate signal intensity when performing T1-weighted imaging (T1WI), heterogeneous high signal intensity when performing short tau inversion recovery MRI, and heterogeneous high signal intensity when performing fat-saturated CE-T1WI. The CI curves of VAs were found to exhibit a specific pattern: Of the 29 CI curves, 23 (79.3%) showed early weak enhancement, followed by a plateau leading up to 400-600 sec. An imaging-based diagnostic diagram was ultimately formulated. This diagram can act as an aid for radiologists when they are expecting to find a VA, and hopefully serve the purpose of simplifying the diagnostic process. Taken together, the findings of the present study indicated that DCE-MRI may be considered a useful tool for the diagnosis of VAs.
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Affiliation(s)
- Wlla E. Al-Hammad
- Department of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
- Department of Oral Medicine and Oral Surgery, Faculty of Dentistry, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Mamiko Fujikura
- Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Miki Hisatomi
- Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Shunsuke Okada
- Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Luciana Munhoz
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo 05508-000, Brazil
| | - Toshiyuki Kawazu
- Department of Oral and Maxillofacial Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
| | - Yohei Takeshita
- Department of Oral and Maxillofacial Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
| | - Mariko Fujita
- Department of Oral and Maxillofacial Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
| | - Yoshinobu Yanagi
- Department of Dental Informatics, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8525, Japan
| | - Jun-Ichi Asaumi
- Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, Okayama 700-8558, Japan
- Department of Oral and Maxillofacial Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
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Bertino FJ, Hawkins CM. Contemporary management of extracranial vascular malformations. Pediatr Radiol 2023; 53:1600-1617. [PMID: 37156889 DOI: 10.1007/s00247-023-05670-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 05/10/2023]
Abstract
Vascular malformations are congenital vascular anomalies that originate because of disorganized angiogenesis, most commonly from spontaneous somatic genetic mutations. The modern management of vascular malformations requires a multidisciplinary team that offers patients the gamut of medical, surgical, and percutaneous treatment options with supportive care. This manuscript discusses the standard and contemporary management strategies surrounding extracranial vascular malformations and overgrowth syndromes.
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Affiliation(s)
- Frederic J Bertino
- Department of Radiology, Interventional Radiology Section, NYU Langone Health/NYU Grossman School of Medicine, 2nd Floor Radiology-Tisch Hospital, 550 First Avenue, New York, NY, 10016, USA.
| | - C Matthew Hawkins
- Department of Radiology, Division of Interventional Radiology, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Review of diagnosis, differential diagnosis, and management of retroperitoneal lymphangioma. Jpn J Radiol 2023; 41:283-301. [PMID: 36327088 DOI: 10.1007/s11604-022-01356-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
Lymphatic malformation (LM) is the currently preferred term for what was previously known as lymphangioma. Retroperitoneal LMs are extremely rare, benign, cystic masses that arise from lymphatic vessels. They can be challenging to diagnose because they resemble other retroperitoneal cystic tumors. The development of treatment strategies for rare diseases, including retroperitoneal LM, requires the acquisition of new knowledge to enhance our understanding of the disease progression. Therefore, we present an update regarding fundamental and advanced issues associated with retroperitoneal LM. This review describes the epidemiology, histopathology, biomedicine, clinical manifestations, radiological features, differential diagnosis, and management of this lesion.
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Beqo BP, Gasparella P, Flucher C, Tschauner S, Brcic I, Haxhija EQ. Subcutaneous Granuloma Annulare vs. Subcutaneous Vascular Malformations in Children: A Diagnostic Challenge. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020362. [PMID: 36832491 PMCID: PMC9955411 DOI: 10.3390/children10020362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVES There are various subcutaneous lesions in children and often there is difficulty in obtaining an accurate diagnosis by non-invasive diagnostic procedures. Subcutaneous granuloma annulare (SGA) is a rare granulomatous disease that, even after imaging, is often mistaken for a low-flow subcutaneous vascular malformation (SVM). This study aimed to accurately identify clinical and imaging clues to distinguish SGA from low-flow SVM. METHODS We retrospectively analyzed complete hospital records of all children with a confirmed diagnosis of SGA and low-flow SVM who underwent MR imaging at our institution from January 2001 to December 2020. Their disease history, clinical and imaging findings, management, and outcome were evaluated. RESULTS Among 57 patients with granuloma annulare, we identified 12 patients (nine girls) with a confirmed SGA diagnosis who underwent a preoperative MRI. Their median age was 3.25 years (range 2-5 years). Of 455 patients diagnosed with vascular malformations, 90 had malformations limited to the subcutaneous area. Among them only 47 patients with low-flow SVM were included in the study and further analyzed. Our SGA cohort had a female predilection (75%) and a short history of lump appearance of 1.5 months. SGA lesions were immobile and firm. Before MRI, patients underwent initial evaluation by ultrasound (100%) and X-ray (50%). Surgical tissue sampling was performed in all SGA patients to establish a diagnosis. All 47 patients with low-flow SVM were diagnosed correctly by MRI. A total of 45 patients (96%) underwent surgical resection of the SVM. A careful retrospective review of imaging findings of patients with SGA and SVM showed that SGA present as homogenous lesions in the shape of an epifascial cap with a typical broad fascial base extending towards the subdermal tissue in the middle of the lesion. In contrast, SVMs always present with variable-sized multicystic or tubular areas. CONCLUSIONS Our study shows clear clinical and imaging differences between low-flow SVMs and SGA. SGA presents characteristically in the shape of a homogenous "epifascial cap," which distinguishes these lesions from multicystic heterogenous SVMs.
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Affiliation(s)
- Besiana P. Beqo
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, A-8036 Graz, Austria
- Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Paolo Gasparella
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, A-8036 Graz, Austria
- VASCERN VASCA European Reference Centre, Bichat-Claude Bernard Hospital, 75018 Paris, France
| | - Christina Flucher
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, A-8036 Graz, Austria
- VASCERN VASCA European Reference Centre, Bichat-Claude Bernard Hospital, 75018 Paris, France
| | - Sebastian Tschauner
- Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, A-8036 Graz, Austria
| | - Iva Brcic
- Institute of Pathology, Medical University of Graz, A-8036 Graz, Austria
| | - Emir Q. Haxhija
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, A-8036 Graz, Austria
- Institute of Pathology, Medical University of Graz, A-8036 Graz, Austria
- Correspondence: ; Tel.: +43-(0)316-38513762; Fax: +43-(0)316-38513775
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8
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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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Scollan ME, Azimov N, Garzon MC, Tulin-Silver S. An overview of interventional radiology techniques for the diagnosis and management of vascular anomalies: Part 1. Pediatr Dermatol 2023; 40:242-249. [PMID: 36623539 DOI: 10.1111/pde.15246] [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: 06/29/2022] [Accepted: 12/24/2022] [Indexed: 01/11/2023]
Abstract
Minimally invasive percutaneous and endovascular strategies performed by interventional radiologists have become the mainstays of treatment for vascular anomalies, with improved outcomes, decreased complication rates, and reduced morbidity. The aim of this article is to introduce physicians who care for patients with vascular anomalies to state-of-the-art advancements in interventional radiology (IR) for diagnosis and treatment. Part 1 of this review will focus on sclerotherapy and cryoablation. Part 2 will discuss embolization, endovenous laser ablation, and image-guided percutaneous biopsy. Select vascular anomalies will be discussed as examples to highlight IR diagnostic and/or treatment techniques.
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Affiliation(s)
- Margaret E Scollan
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Neyra Azimov
- Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Maria C Garzon
- Departments of Dermatology and Pediatrics, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Sheryl Tulin-Silver
- Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
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Wu Z, Zou Y, Fu R, Jin P, Yuan H. A nomogram for predicting sclerotherapy response for treatment of lymphatic malformations in children. Eur J Med Res 2022; 27:209. [PMID: 36271467 PMCID: PMC9585839 DOI: 10.1186/s40001-022-00844-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose In this manuscript, we purposed to identify the prognostic factors for treatment of lymphatic malformations in children using polidocanol foam combined with pingyangmycin and to construct nomogram for predicting sclerotherapy response. Methods A retrospective analysis of 77 children having LMs who underwent sclerotherapy using polidocanol foam combined with pingyangmycin under ultrasound display from January 2017 to April 2020 was done. The clinical response was graded as excellent (≥ 90%), good (≥ 50%, < 90%), and poor (< 50%). More than 50% was considered as acceptable response. Prognostic factors were identified by Pearson’s Chi-square or Fisher’s exact test and multivariable logistic regression model was used to construct a nomogram to predict sclerotherapy response. The discrimination and calibration of nomogram were verified through the receiver operating characteristic cure and calibration plots. Results The mean number of treatment sessions was 3.1 (range, 1–6). Among 77 patients, 58 patients (75.3%) had excellent response to treatment (≥ 90%) and 68 patients (88.3%) had an acceptable response (≥ 50%, < 90%). Clinical disfigurement (P = 0.014), skin discoloration (P = 0.040), morphological subtype (P < 0.001) and extent of the lesion (P < 0.001) correlated with clinical response to sclerotherapy in LMs. Sclerotherapy response was predicted through nomogram constructed in this study, which shows good calibration and discrimination. Also, focal lesion and macrocystic or mixed morphological subtype lesion were seen more often in lower number of treatment sessions among the patients with excellent response. Conclusions An acceptable response to sclerotherapy using polidocanol foam combined with pingyangmycin was achieved in majority of LMs in children with extremely low complication rates. Nomogram based on the prognostic factors of sclerotherapy response for LMs in children was shown to possess an excellent performance to predict the probability of LMs sclerotherapy response.
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Affiliation(s)
- Zhiping Wu
- Department of Plastic Surgery, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Yun Zou
- Department of Plastic Surgery, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Ronghua Fu
- Department of Plastic Surgery, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Pingliang Jin
- Department of Plastic Surgery, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Hua Yuan
- Department of Plastic Surgery, Jiangxi Provincial Children's Hospital, Nanchang, China.
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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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12
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Vascular Anomalies. Dermatol Clin 2022; 40:339-343. [DOI: 10.1016/j.det.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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13
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Walter A, Calite E, Müller A, Kalff JC, Meyer C, Geipel A, Gembruch U, Schreiner C. Prenatal diagnosis and management of a giant intrahepatic arteriovenous malformation—Sonographic findings, clinical implications, and treatment. Clin Case Rep 2022; 10:e6175. [PMID: 35937027 PMCID: PMC9347331 DOI: 10.1002/ccr3.6175] [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: 04/04/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Adeline Walter
- Department of Obstetrics and Prenatal Medicine University Hospital Bonn Bonn Germany
| | - Elina Calite
- Department of Obstetrics and Prenatal Medicine University Hospital Bonn Bonn Germany
| | - Andreas Müller
- Department of Neonatology and Pediatric Intensive Care Medicine University Hospital Bonn Bonn Germany
| | - Jörg C. Kalff
- Department of Surgery Bonn University Hospital, University Hospital Bonn Bonn Germany
| | - Carsten Meyer
- Department of Diagnostic and Interventional Radiology Bonn University Hospital, University Hospital Bonn Bonn Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine University Hospital Bonn Bonn Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine University Hospital Bonn Bonn Germany
| | - Christine Schreiner
- Department of Neonatology and Pediatric Intensive Care Medicine University Hospital Bonn Bonn Germany
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14
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Gu F, Yu J, Mi J. Radial arteriovenous fistula complicated with ischemic steal syndrome after transradial cardiac catheterization: a case report and literature review. BMC Surg 2022; 22:106. [PMID: 35313862 PMCID: PMC8939090 DOI: 10.1186/s12893-022-01562-7] [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: 12/08/2021] [Accepted: 03/15/2022] [Indexed: 11/27/2022] Open
Abstract
Background The radial arteriovenous fistula (AVF) is a rare complication occurring after transradial cardiac catheterization. Patients with AVF typically present with signs of venous dilation, such as swelling or palpable thrills. However, neurological complications secondary to radial AVFs are rare. This paper reported a rare case of ischemic steal syndrome that occurred 11 months after the transradial cardiac catheterization, most likely as a consequence of radial arteriovenous fistula. Case presentation This paper described a case of a 73-year-old female, who complained of right forearm swelling and radial 1–3 fingers numbness for several months after the catheterized stent surgery through radial approach. Upon Clinical examination, this patient presented with a slight bump and palpable thrill at the distal third of right forearm, and the sensory of radial 1–3 fingers and pinch force was compromised. The Ultrasonography and computed tomography angiography (CTA) of the upper extremity revealed AVF between the right radial artery and the adjacent vein. Microsurgery was performed successfully to ligate the fistula and reconstruct the radial artery. The numbness has gradually improved about 1 week after the surgery, with no recurred swelling. The two-point pinch force and digital sensitivity recovered at the 20-month follow-up. What’s more, due to the scarcity of cases, the optimal therapy for iatrogenic radial AVF is controversial. Accordingly, we provided a literature review of previous reports of catheter-related radial AVFs and proposed an algorithm to manage them. Conclusions We believe that once an AVF is diagnosed, early treatment options such as compression or surgery are necessary to relieve symptoms and prevent further complications. Otherwise, serious complications can occur, including the ischemic steal syndrome.
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Affiliation(s)
- Fengming Gu
- Medical College, Soochow University, Suzhou, Jiangsu, China
| | - Jiong Yu
- Department of Sports Medicine, Wuxi 9th People's Hospital Affiliated to Soochow University, 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Jingyi Mi
- Department of Sports Medicine, Wuxi 9th People's Hospital Affiliated to Soochow University, 999 Liangxi Road, Wuxi, 214062, Jiangsu, China.
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15
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Schmidt VF, Olivieri M, Häberle B, Masthoff M, Deniz S, Sporns PB, Wohlgemuth WA, Wildgruber M. Interventional Treatment Options in Children with Extracranial Vascular Malformations. Hamostaseologie 2022; 42:131-141. [PMID: 35263769 DOI: 10.1055/a-1728-5686] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Extracranial vascular malformations vary greatly and belong to the complex field of orphan diseases and can involve all segments of the vascular tree: arteries, capillaries, and veins, and similarly the lymphatic system. The classification according to the International Society for the Study of Vascular Anomalies (ISSVA) represents an important guidance for selecting appropriate therapy. Although many of the principles of endovascular treatment, including image-guided sclerotherapy and embolization, are similar in adult and pediatric practice, there are some distinct differences regarding the treatment of vascular malformations of children. Thus, it is crucial to involve longer-term plan about managing these chronic diseases and their impact on a growing child. This review provides a detailed overview over the clinical presentation of venous, lymphatic, and arteriovenous malformations in children and emphasizes the specifics of their interventional treatment options, including distinct pediatric dose limitations and procedure-related side effects.
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Affiliation(s)
- Vanessa F Schmidt
- Department of Radiology, Ludwig Maximilian University Hospital, Munich, München, Germany
| | - Martin Olivieri
- Paediatric Thrombosis and Haemostasis Unit, Dr. von Hauner Children's Hospital Munich, Ludwig Maximilian University, Munich, Germany
| | - Beate Häberle
- Department for Pediatric Surgery, Ludwig Maximilian University Hospital, Munich, München, Germany
| | - Max Masthoff
- Clinic of Radiology, University Hospital Muenster, Muenster, Germany
| | - Sinan Deniz
- Department of Radiology, Ludwig Maximilian University Hospital, Munich, München, Germany
| | - Peter B Sporns
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
| | - Walter A Wohlgemuth
- Clinic and Policlinic of Diagnostic Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Wildgruber
- Department of Radiology, Ludwig Maximilian University Hospital, Munich, München, Germany
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16
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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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17
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Abdel Razek AAK, Elmokadem AH, Soliman M, Mukherji SK. MR Imaging of Vascular Malformations and Tumors of Head and Neck. Magn Reson Imaging Clin N Am 2021; 30:199-213. [PMID: 34802579 DOI: 10.1016/j.mric.2021.07.005] [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: 10/19/2022]
Abstract
Soft tissue vascular anomalies show a wide heterogeneity of clinical manifestations and imaging features. MR imaging has an important role in the diagnosis and management of vascular lesions of the head and neck. MR angiography is mandatory in cases of arteriovenous and combined malformations to assess the high-flow nature/component of the lesions and plan therapy. Infantile hemangiomas can be differentiated from congenital hemangiomas by clinical course. Reactive vascular tumors have nonspecific features similar to infantile hemangiomas. Locally malignant and malignant vascular tumors have irregular borders, infiltration of different tissue planes, and lower apparent diffusion coefficient values than benign vascular tumors.
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Affiliation(s)
| | - Ali H Elmokadem
- Department of Diagnostic Radiology, Mansoura University Faculty of Medicine, Elgomhoria Street, Mansoura 35512, Egypt
| | - Mosad Soliman
- Department of Vascular Surgery, Mansoura University Faculty of Medicine, Elgomhoria Street, Mansoura 35512, Egypt
| | - Suresh K Mukherji
- Marian University, Head and Neck Radiology, ProScan Imaging, Carmel, IN, USA.
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18
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De Corso E, Cina A, Salonna G, Di Cintio G, Gaudino S, Panfili M, Colosimo C, Paludetti G. Sclerotherapy with polidocanol microfoam in head and neck venous and lymphatic malformations. ACTA ACUST UNITED AC 2021; 42:116-125. [PMID: 34297013 PMCID: PMC9131995 DOI: 10.14639/0392-100x-n1310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/20/2021] [Indexed: 01/10/2023]
Abstract
Objective Polidocanol sclerotherapy of head and neck venous malformations (VMs) and lymphatic malformations (LMs) has been reported only in limited series. In this manuscript we evaluated the efficacy and safety of polidocanol sclerotherapy in a series of head and neck venous and lymphatic malformations. Methods This retrospective observational study analysed data on 20 head and neck VMs and LMs that underwent to percutaneous or endoscopic intra-lesional 3% polidocanol microfoam sclerotherapy at our institution. Clinical response was ranked as excellent, moderate and poor based on volume reduction by MRI and resolution of symptoms. Results The median volume decreased from 19.3 mL to 5.8 mL after sclerotherapy (mean volume reduction: 72.98 ± 16.1%). An excellent-moderate response was observed in 94.4% of cases. We observed a mean volume reduction of 79.5 ± 16.1 in macrocystic LMs, of 76.1 ± 13.0% in VMs, of 60.5 ± 10.9% in mixed lymphatic ones and 42.5% in microcystic lymphatic ones. Conclusions Polidocanol sclerotherapy appears to be an effective and safe treatment for venous and lymphatic head and neck malformations. We observed the best responses in macrocystic LMs and VMs, whereas mixed lymphatic ones showed a moderate response and microcystic lymphatic ones a poor response.
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Affiliation(s)
- Eugenio De Corso
- UOC Otorinolaringoiatria, Area Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Cina
- UOC Radiodiagnostica e Neuroradiologia, Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giampiero Salonna
- UOC Otorinolaringoiatria, Area Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Di Cintio
- UOC Otorinolaringoiatria, Area Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Gaudino
- UOC Radiodiagnostica e Neuroradiologia, Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Panfili
- UOC Radiodiagnostica e Neuroradiologia, Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cesare Colosimo
- UOC Radiodiagnostica e Neuroradiologia, Dipartimento di Diagnostica per Immagini, Radioterapia, Oncologia ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gaetano Paludetti
- UOC Otorinolaringoiatria, Area Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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19
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Evans A, Nguyen B, Nassar G. Discovery of a large axillary artery vascular malformation during the evaluation of a patient with hemodialysis access-induced distal ischemia: Implications on pathophysiology and management. Semin Dial 2021; 34:380-383. [PMID: 34291828 DOI: 10.1111/sdi.12999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/17/2021] [Accepted: 06/03/2021] [Indexed: 11/29/2022]
Abstract
A patient with a 6-year-old left upper arm brachial cephalic AVF presented with symptoms of hemodialysis access-induced distal ischemia (HAIDI). Physical exam findings showed a well-developed AVF, but compression of the AVF aggravated arm pain and induced diffuse erythema of the left upper extremity. Angiographic evaluation disclosed the presence of a large axillary artery vascular malformation (AVM) as well as distal forearm hypo-perfusion. We elected to publish this case report to describe the interesting physical exam findings related to the AVM, and discuss HAIDI treatment options that are peculiar to this case. We also highlight the importance of thorough vascular evaluation prior to AV access creation as well as during the investigation of the cause of HAIDI.
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Affiliation(s)
- Andrew Evans
- Renal Division, Department of Internal Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Binh Nguyen
- North Shepherd Dialysis Access Management Center; Nephrology, Dialysis and Transplantation Associates, The Kidney Institute, Houston, Texas, USA
| | - George Nassar
- Renal Division, Department of Internal Medicine, Houston Methodist Hospital, Houston, Texas, USA.,North Shepherd Dialysis Access Management Center; Nephrology, Dialysis and Transplantation Associates, The Kidney Institute, Houston, Texas, USA.,Weill Cornell Medicine, Houston, Texas, USA
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20
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Gupta D, Gupta S, Mittal A, Garg P. Diagnosis and Management of Cavernous Hemangioma of the Tongue with Sclerosing Agents: A Case Report and Review of Literature. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2021. [DOI: 10.29333/ejgm/11016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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21
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Bertino F, Trofimova AV, Gilyard SN, Hawkins CM. Vascular anomalies of the head and neck: diagnosis and treatment. Pediatr Radiol 2021; 51:1162-1184. [PMID: 33860862 DOI: 10.1007/s00247-021-04968-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/27/2020] [Accepted: 01/07/2021] [Indexed: 01/19/2023]
Abstract
Vascular malformations and vascular tumors comprise the two specific subsets of vascular anomalies that arise as a result of disorganized angiogenesis and neoplasm, respectively. Malformations are separate entities from vascular tumors (e.g., hemangiomas) and are recognized by the International Society for the Study of Vascular Anomalies (ISSVA) as such. Vascular malformations are classified into four main groups: simple, combined, anomalies of major vessels, and those associated with other vascular anomalies. Vascular tumors are neoplastic growths of blood vessels and are morphologically and molecularly distinct from malformations but can arise in the head and neck and have syndromic association. Head and neck vascular anomalies are not uncommon in the pediatric population and require special care in the workup, diagnostic imaging and clinical care. The purpose of this manuscript is to discuss the diagnosis and management of the most common intracranial and extracranial vascular malformations and tumors in the head and neck in children and adolescents.
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Affiliation(s)
- Frederic Bertino
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Room BG03, Atlanta, GA, 30322, USA.
| | - Anna V Trofimova
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Room BG03, Atlanta, GA, 30322, USA
| | - Shenise N Gilyard
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Room BG03, Atlanta, GA, 30322, USA
| | - C Matthew Hawkins
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Room BG03, Atlanta, GA, 30322, USA.,Division of Pediatric Radiology, Division of Interventional Radiology and Image Guided Medicine, Children's Healthcare of Atlanta, Emory + Children's Pediatric Institute, Atlanta, GA, USA
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22
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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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23
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Rectosigmoidal manifestations of venous malformations: MR imaging findings and interdisciplinary therapeutic modalities. Sci Rep 2019; 9:19916. [PMID: 31882623 PMCID: PMC6934467 DOI: 10.1038/s41598-019-56217-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 12/06/2019] [Indexed: 12/11/2022] Open
Abstract
The aim of this study was to identify the frequency of rectosigmoidal involvement in patients with venous malformations (VM) of the lower extremities and to demonstrate multidisciplinary therapeutic options. The medical records and magnetic resonance images (MRI) of patients with VM of the lower extremities, over a six-year period, were reviewed retrospectively in order to determine the occurrence of rectosigmoidal involvement. Vascular interventions, surgical treatments, percutaneous and hybrid (endoscopy-guided angiography) sclerotherapy and procedural complications (according to Clavien-Dindo classification) were also noted. Of the 378 patients with vascular malformation of the lower limbs, 19 patients (5%) had documented venous rectosigmoidal malformation. All of these 19 patients reported episodes of rectal bleeding, while seven patients (36.8%) also had anemia. All patients underwent endoscopy. By endoscopy, seven patients (36.8%) showed discreet changes, and 12 patients (63.2%) showed pronounced signs of submucosal VM with active (47.3%) or previous (15.7%) bleeding. Treatment was performed in all patients with pronounced findings. Six patients underwent endoscopy-guided hybrid sclerotherapy, one patient underwent endoscopic tissue removal, one patient received percutaneous sclerotherapy and one patient received a combination of transvenous embolization and hybrid sclerotherapy. Three patients required open surgery. No complications occurred after conservative treatments; however, one complication was reported after open surgery. None of the treated patients reported further bleeding and anemia at the end of the follow-up period. In this cohort, rectosigmoidal VM occurred in 5% of patients presenting with a high incidence of rectal bleeding. Percutaneous or endoscopy-guided hybrid sclerotherapy appeared to be a safe and effective alternative to surgery.
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24
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Leszczynska M, Jodeh DS, Reed D, Lynskey EM, Bittles MA, Mayer JL, Rottgers SA. Alveolar soft-part sarcoma: Case demonstrating principles for uncommon vascular lesions. Pediatr Int 2019; 61:978-981. [PMID: 31219648 DOI: 10.1111/ped.13920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/22/2019] [Accepted: 06/18/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Alveolar soft-part sarcoma (ASPS) is an uncommon malignancy that may present in a manner similar to benign vascular tumors. METHODS A 6-year-old boy with autism spectrum disorder was referred to the Johns Hopkins All Children's Hospital vascular anomalies clinic for the evaluation of a tongue mass. RESULTS Prior to the presentation, at 5 years of age, neck computed tomography (CT) was performed. This showed a well circumscribed, enhancing mass at the anterior aspect of the tongue. The radiologic impression was that this lesion was most likely a hemangioma. Two years later, the patient was evaluated in the vascular anomalies clinic. At that examination a 2-3 cm swelling was noted on the dorsal aspect of the tongue. The mass was fleshy and firm with discrete borders. Handheld Doppler examination indicated a high-flow lesion. The patient underwent an excisional biopsy. The lesion was identified as an alveolar soft-part sarcoma based on pathologic characteristics. CONCLUSION Familiarity with common vascular tumors and malformations allows providers to diagnose the majority of these lesions on a combination of clinical history and physical examination. Atypical and combined lesions do benefit from imaging to help characterize and aid in the differential diagnosis. Biopsy enables definitive diagnosis but is necessary in the minority of cases. When in doubt, referral to a specialized, multidisciplinary vascular anomalies clinic will ensure that these patients receive management for this challenging collection of conditions.
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Affiliation(s)
- Maria Leszczynska
- Department of General Pediatrics, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Diana S Jodeh
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Damon Reed
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Elisa M Lynskey
- Division of Otolaryngology, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Mark A Bittles
- Department of Radiology, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Jennifer Lr Mayer
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - S Alex Rottgers
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
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25
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Hawkins CM, Chewning RH. Diagnosis and Management of Extracranial Vascular Malformations in Children: Arteriovenous Malformations, Venous Malformations, and Lymphatic Malformations. Semin Roentgenol 2019; 54:337-348. [PMID: 31706367 DOI: 10.1053/j.ro.2019.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- C Matthew Hawkins
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA; Division of Pediatric Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory + Children's Pediatric Institute, Children's Healthcare of Atlanta at Egleston, Atlanta, GA.
| | - Rush H Chewning
- Division of Vascular and Interventional Radiology, Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
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26
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Anatomical anomalies and variations of main thoracic vessels in dogs: a computed tomography study. J Vet Cardiol 2019; 21:57-66. [DOI: 10.1016/j.jvc.2018.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 08/12/2018] [Accepted: 08/20/2018] [Indexed: 11/19/2022]
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27
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Morgado M, Lobo S, Vieira E, Lobo L, Gonçalves M. Combined surgical and medical treatment of a retroperitoneal lymphatic-venous malformation presenting with significant haemorrhage. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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28
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Esposito F, Di Serafino M, Severino R, Vafina Z, Ferrara D, Zeccolini M. Mesenteric infantile hemangioma: diagnostic work-up. Quant Imaging Med Surg 2018; 8:252-256. [PMID: 29675365 DOI: 10.21037/qims.2017.09.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A very rare localization of infantile hemangioma (IH) is mesentery. It may manifest with intra-luminal or intra-peritoneal bleeding. Here there is the case of a 45-day-old infant, presenting with anemia and poor growth, subsequently referred to an uncommon hemangioma of the mesentery. As well as for most of IH, conservative treatment with only propranolol resulted in the disappearance of the lesion. Here we analyze ultrasound and magnetic resonance (MR) features of this uncommon lesion, trying to underline main characteristics at imaging in order to monitor the response to therapy.
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Affiliation(s)
| | - Marco Di Serafino
- Department of Emergency Radiology, San Carlo Hospital, Potenza, Italy
| | - Rosa Severino
- Radiology Department, "Federico II" University Hospital, Napoli, Italy
| | - Zukhra Vafina
- Radiology Department, "Federico II" University Hospital, Napoli, Italy
| | - Dolores Ferrara
- Radiology Department, "Federico II" University Hospital, Napoli, Italy
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30
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Abstract
Vascular malformations are congenital vascular anomalies with normal endothelial turnover, which can affect the whole vessel tree (arterial, capillary or lymphatic) both as isolated defects or as part of a syndrome. Developmental errors during embryogenesis, such as abnormal signaling processes that control the apoptosis, maturation and growth of vascular cells, lead to the persistence of vascular plexus cells with some degree of differentiation. Vascular malformations are usually present at birth, although symptoms or complications may be manifested later. Since the overwhelming majority are symptomatic, treatment is indicated which is often aimed only at improving the symptoms by controlling the size.
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Affiliation(s)
- S Mylonas
- Klinik und Poliklinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - S Brunkwall
- Klinik und Poliklinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - J Brunkwall
- Klinik und Poliklinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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31
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Bashir U, Shah S, Jeph S, O'Keeffe M, Khosa F. Magnetic Resonance (MR) Imaging of Vascular Malformations. Pol J Radiol 2017; 82:731-741. [PMID: 29657639 PMCID: PMC5894044 DOI: 10.12659/pjr.903491] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 03/05/2017] [Indexed: 11/24/2022] Open
Abstract
Vascular malformations pose a diagnostic and therapeutic challenge due to the broad differential diagnosis as well as common utilization of inadequate or inaccurate classification systems among healthcare providers. Therapeutic approaches to these lesions vary based on the type, size, and extent of the vascular anomaly, necessitating accurate diagnosis and classification. Magnetic resonance (MR) imaging (MRI) is an effective modality for classifying vascular anomalies due to its ability to delineate the extent and anatomic relationship of the malformation to adjacent structures. In addition to anatomical mapping, the complete evaluation of vascular anomalies includes hemodynamic characterization. Dynamic time-resolved contrast-enhanced MR angiography provides information regarding hemodynamics of vascular anomalies, differentiating high- and low-flow vascular malformations. Radiologists must identify the MRI features of vascular malformations for better diagnosis and classification.
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Affiliation(s)
- Usman Bashir
- Division of Imaging Research and Biomedical, Engineering, St. Thomas' Hospital, London, ON, Canada
| | - Samd Shah
- Department of Diagnostic Radiology, Geisinger Medical Center, Danville, PA, U.S.A
| | - Sunil Jeph
- Department of Diagnostic Radiology, Geisinger Medical Center, Danville, PA, U.S.A
| | - Michael O'Keeffe
- Division of Emergency and Trauma Radiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Faisal Khosa
- Department of Diagnostic Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
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Schultz T. Solitary fibrous tumour: A rare find on ultrasound. SONOGRAPHY 2017. [DOI: 10.1002/sono.12119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Horbach SE, Utami AM, Meijer-Jorna LB, Sillevis Smitt J, Spuls PI, van der Horst CM, van der Wal AC. Discrepancy between the clinical and histopathologic diagnosis of soft tissue vascular malformations. J Am Acad Dermatol 2017; 77:920-929.e1. [DOI: 10.1016/j.jaad.2017.03.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/22/2017] [Accepted: 03/29/2017] [Indexed: 12/01/2022]
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Sadick M, Wohlgemuth WA, Huelse R, Lange B, Henzler T, Schoenberg SO, Sadick H. Interdisciplinary Management of Head and Neck Vascular Anomalies: Clinical Presentation, Diagnostic Findings and Minimalinvasive Therapies. Eur J Radiol Open 2017; 4:63-68. [PMID: 28540347 PMCID: PMC5432672 DOI: 10.1016/j.ejro.2017.05.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/03/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Vascular anomalies are included in the 30 000 rare diseases worldwide affecting less than 5/10 000 people. Depending on their morphology and biological properties, they can cause varied disorders with organ involvement. Almost 60% of vascular anomalies have a predilection for the head and neck region in children. Clinical and scientific effort to establish interdisciplinary management concepts for vascular anomalies is increasing worldwide. METHODS Especially in the head and neck region, clinical impairment and organ dysfunction is associated with cosmetic issues that may represent a physical and psychological issue for the patient. Correct diagnosis, based on clinical presentation and symptoms, is a prerequisite for appropriate therapy, ranging from conservative management to a spectrum of minimally invasive treatment options. We searched PubMed for German and English language published data until December 2016 with focus on clinical studies, review articles and case reports on vascular anomalies with a focus on the head and neck region. RESULTS The last ISSVA update in 2014 has contributed to a better understanding of vascular anomalies, classifying them in vascular tumors and vascular malformations. The predominant representatives of vascular tumors are congenital and infantile hemangiomas. Infantile hemangiomas have the ability of spontaneous regression in more than 80%. Patients with symptomatic growing hemangiomas with ulcerations, bleeding complications and restriction of hearing, swallowing disorder, impairment of vision, or cosmetic dysfigurement require treatment. Therapies include oral propanolol, transcatheter embolization and surgery. Vascular malformations tend to progress with patientś age and are subdivided in slow flow and fast flow lesions. Symptomatic slow flow lesions, e.g. venous and lymphatic malformations, benefit from percutaneous sclerotherapy. Fast flow lesions, as arteriovenous malformations, are rare but undoubtedly therapeutically the most challenging vascular anomaly. Depending on location and size, they may require multiple transcatheter embolization procedures for successful occlusion of the AVM. CONCLUSIONS This review provides knowledge on the current ISSVA classification of vascular anomalies, their clinical presentation, diagnostic evaluation and minimally invasive therapy options to encourage the establishment of a comprehensive interdisciplinary management for head and neck vascular anomalies.
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Affiliation(s)
- Maliha Sadick
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Walter A. Wohlgemuth
- Department of Radiology, University Medical Center Regensburg, Franz-Josef- Strauß-Allee 11, 93053 Regensburg, Germany
| | - Roland Huelse
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Bettina Lange
- Department of Pediatric Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Stefan O. Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Haneen Sadick
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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Castillo SD, Vanhaesebroeck B, Sebire NJ. Phosphoinositide 3-kinase: a new kid on the block in vascular anomalies. J Pathol 2016; 240:387-396. [PMID: 27577520 DOI: 10.1002/path.4802] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/17/2016] [Accepted: 08/26/2016] [Indexed: 12/13/2022]
Abstract
Vascular anomalies are broadly divided into vascular tumours and malformations. These lesions are composed of abnormal vascular elements of various types, and mainly affect infants, children, and young adults. Vascular anomalies may be painful, may be complicated by bleeding, infection, or organ dysfunction, and can have secondary effects on other tissues. Current treatment strategies include surgical excision, pulsed laser, and sclerotherapy, which are invasive, with risks of recurrence. There are growing pharmacological options for these vascular anomalies, but, to date, no specific targeted therapies have been developed. Phosphoinositide 3-kinases (PI3Ks) constitute a family of lipid kinases that are involved in signal transduction and vesicular traffic, and that modulate important cellular processes such as proliferation, growth, and migration. Recent findings have indicated that the PI3K signalling pathway is important in the pathogenesis of vascular anomalies. This provides an opportunity to use PI3K inhibitors, which are in clinical trials for cancer treatment, for such lesions. Here, we provide an update on the classification of vascular anomalies, with their major features, and discuss the role of the PI3K signalling pathway in the pathogenesis of vascular anomalies, and their clinical implications and therapeutic opportunities. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | - Neil J Sebire
- UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK
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Henzler T, Vogler N, Lange B, Dally F, Meyer M, Schoenberg SO, Sadick M. Low dose time-resolved CT-angiography in pediatric patients with venous malformations using 3rd generation dual-source CT: Initial experience. Eur J Radiol Open 2016; 3:216-22. [PMID: 27570804 PMCID: PMC4990662 DOI: 10.1016/j.ejro.2016.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 08/09/2016] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To prospectively evaluate the diagnostic value and radiation dose of time-resolved CT-Angiography (4D-CTA) in pediatric patients with venous malformations using 3rd generation dual-source CT (DSCT) at 70 kVp tube voltage. METHODS Between November 2014 and August 2015, seven children (2 male, 5 female; median age, 9 years; range 3-12 years) with suspected peripheral, non-cerebral, venous malformations were included in this feasibility study and underwent US, MRI and 4D-CTA. All three imaging modalities were analyzed and compared individually by an experienced interventional radiologist and a pediatric surgeon using a 5-point Likert scale, with regard to diagnosis of the vascular anomaly, additional information like presence of thrombophlebitis and lesion extension, flow dynamics, localization, volume and significance for treatment planning. For quantitative statistical analysis, an unifactorial analysis of variance was performed for every parameter and all three imaging modalities. Radiation dose values as expressed by the volume CT dose index (CTDIvol) and dose-length product (DLP) were recorded for of all patients. RESULTS Three out of six patients had isolated type I venous malformations without peripheral venous drainage which could be demonstrated on MRI and CT. In two out of six patients a type II venous malformation with drainage into normal veins was diagnosed. In one case, 4D-CT was the only imaging modality that revealed a slow-flow venous malformation with shunting supply by a hypodynamic arterial feeder. TREATMENT PLANNING 4D-CTA was rated as the best imaging modality for treatment planning with agreement between radiologist and surgeon, especially with respect to the hemodynamics of the venous malformation. CONCLUSIONS 4D-CTA at 70 kVp is a fast imaging modality that provides comprehensive diagnostic information of venous malformations in pediatric patients and is very valuable for therapy planning. Radiation dose of 4D-CTA must be weighted against the diagnostic information as well as the potential risk for sedation and contrast administration during MRI.
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Affiliation(s)
- Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Nils Vogler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Bettina Lange
- Department of Pediatric Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Franz Dally
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Mathias Meyer
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Stefan O. Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Maliha Sadick
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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Abstract
A 31-year-old female student was referred to physical therapy with a chief complaint of proximal, posterior left thigh pain that began insidiously 12 months prior, and progressively worsened while training for a half-marathon. A mobile, soft mass was identified just inferior to the ischial tuberosity that was tender and painful to palpation, recreating the patient's chief complaint. Radiographic findings were negative for a suspected avulsion fracture at the ischial tuberosity. Therefore, the physician performed musculoskeletal ultrasonography, which revealed a superficial hypoechoic mass with vascular flow. Magnetic resonance imaging and a subsequent biopsy led to the diagnosis of a benign vascular malformation. J Orthop Sports Phys Ther 2016;46(7):607. doi:10.2519/jospt.2016.0410.
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Geramizadeh B, Niakan A, Zolmadjdi N, Marzban M. Appendiceal Hemangioma, Mimicking Acute Appendicitis in a 17-Year-Old Girl. Rare Tumors 2016; 8:6208. [PMID: 27441077 PMCID: PMC4935826 DOI: 10.4081/rt.2016.6208] [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: 09/18/2015] [Revised: 01/12/2016] [Accepted: 01/26/2016] [Indexed: 11/23/2022] Open
Abstract
Epithelial tumors of appendix are not so common, and mesenchymal tumors of the appendix are even less common. Capillary hemangioma of the appendix is an extremely rare event and to the best of our knowledge only 4 cases have been reported in the English literature so far. In this case report we want to explain our experience with an extremely rare occurrence of capillary hemangioma of appendix in a 17-year-old girl presented with right lower quadrant pain that was operated with the clinical impression of acute appendicitis. The patient has been operated as a routine appendectomy with a completely uneventful postoperative period.
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Affiliation(s)
- Bita Geramizadeh
- Department of Pathology, Transplant Research Center, Shiraz University of Medical Sciences , Shiraz, Iran
| | - Amin Niakan
- Department of Pathology, Transplant Research Center, Shiraz University of Medical Sciences , Shiraz, Iran
| | - Nadjmeh Zolmadjdi
- Department of Pathology, Transplant Research Center, Shiraz University of Medical Sciences , Shiraz, Iran
| | - Mahsa Marzban
- Department of Pathology, Transplant Research Center, Shiraz University of Medical Sciences , Shiraz, Iran
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Limb Necrosis Caused by Sclerotherapy When Treating Venous Malformation. EJVES Short Rep 2016; 32:12-13. [PMID: 28856308 PMCID: PMC5576014 DOI: 10.1016/j.ejvssr.2016.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/08/2016] [Accepted: 04/04/2016] [Indexed: 11/23/2022] Open
Abstract
Introduction Percutaneous interventional sclerotherapy has been widely used to treat venous malformation. Satisfactory results have been reported, along with both mild and severe complications. Report A 1.5 year old girl was diagnosed as having a venous malformation of the right vulva and right inner thigh. The patient received sclerotherapy using polidocanol. After the surgery, the right foot and lower leg became pale, and then, a few days later, necrotic. Conclusion Accurate diagnosis and appropriate treatment are challenging for vascular malformations and should only be carried out in centers with ample expertise. Interventional sclerotherapy has been widely used to treat venous malformations. Satisfactory results have been reported along with both mild and severe complications. There are no literature reports of limb necrosis, caused by sclerotherapy, requiring amputation. Treatment of vascular malformations should only be carried out in expert centers with ample expertise.
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40
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Widjaja W, Aggarwala S, Ballieux F, Vandervord J. Facial and Scalp Swelling in the Pediatric Population With Hemophilia: A Diagnosis Pitfall. EPLASTY 2016; 16:ic15. [PMID: 27213025 PMCID: PMC4855352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- W. Widjaja
- The Children's Hospital at Westmead, Westmead, Australia,Correspondence:
| | - S. Aggarwala
- The Children's Hospital at Westmead, Westmead, Australia
| | - F. Ballieux
- The Children's Hospital at Westmead, Westmead, Australia
| | - J. Vandervord
- The Children's Hospital at Westmead, Westmead, Australia
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41
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Nassiri N, Thomas J, Cirillo-Penn NC. Evaluation and management of peripheral venous and lymphatic malformations. J Vasc Surg Venous Lymphat Disord 2016; 4:257-65. [DOI: 10.1016/j.jvsv.2015.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 09/02/2015] [Indexed: 12/18/2022]
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He J, Zhu H, Zhang C, Wang Y, Zheng J, Qiu W. Role of fine needle aspiration cytology in the differential diagnosis of vascular anomalies from other lesions in the head and neck region. Phlebology 2016; 32:34-42. [PMID: 26802064 DOI: 10.1177/0268355515625003] [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
Objective To summarise the role of fine needle aspiration cytology in the differential diagnosis of vascular anomalies from other lesions in the head and neck region by presenting five interesting cases reported from our hospital data. Method Five patients ranging in age from 3 months to 25 years old were diagnosed with vascular anomalies based on their histories, clinical examinations, imaging examinations and ultrasonic testing. The previous diagnosis of these patients were corrected by fine needle aspiration cytology in our hospital and the proper treatment was administered. Result Two cases were wrongly treated in a local hospital. All five of the patients underwent operations after excluding vascular anomalies by fine needle aspiration cytology. Conclusion Fine needle aspiration cytology should be used in the following situations to prevent misdiagnoses and the mistreatment as vascular anomalies: when imaging examination and ultrasonic testing lead to a diagnosis of vascular malformation, but the history or clinical examination does not confirm this diagnosis; when lesions are treated as "vascular malformations" by sclerotherapy, and the hydatid fluid is not like blood or lymph fluid; and when propranolol is used to treat the proliferation stage of "haemangiomas" with without any effect.
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Affiliation(s)
- Jie He
- 1 Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hanguang Zhu
- 1 Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunye Zhang
- 2 Department of oral pathology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanan Wang
- 1 Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiawei Zheng
- 1 Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiliu Qiu
- 1 Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Abstract
To analyze the clinical characteristics and treatment outcomes of vascular anomalies, and determine which therapy is safe and effective. The data of vascular anomalies pediatric patients who arrived at Beijing children's Hospital from January 2001 to December 2014 were analyzed retrospectively, including the influence of gender, age, clinical manifestation, diagnosis, treatment options, and outcomes. As to infantile hemangiomas, the outcomes of different treatments and their adverse reactions were compared. As to spider angioma and cutaneous capillary malformation, the treatment effect of 595 nm pulsed dye laser (PDL) is analyzed. A total number of 6459 cases of vascular anomalies were reclassified according to the 2014 ISSVA classification system. Among them, the gender ratio is 1:1.69, head-and-neck involved is 53.3%, the onset age within the first month is 72.4%, the age of initial encounter that younger than 6 months is 60.1%. The most common anomalies were infantile hemangiomas (42.6%), congenital hemangiomas (14.1%), and capillary malformations (29.9%). In treating infantile hemangiomas, laser shows the lowest adverse reactions rate significantly. Propranolol shows a higher improvement rate than laser, glucocorticoids, glucocorticoids plus laser, and shows no significant difference with propranolol plus laser both in improvement rate and adverse reactions rate. The total improvement rate of 595 nm PDL is 89.8% in treating spider angioma and 46.7% in treating cutaneous capillary malformation. The improvement rate and excellent rate of laser in treating cutaneous capillary malformation are growing synchronously by increasing the treatment times, and shows no significant difference among different parts of lesion that located in a body. Vascular anomalies possess a female predominance, and are mostly occurred in faces. Definite diagnosis is very important before treatment. In treating infantile hemangioma, propranolol is recommended as the first-line agent, and systemic use glucocorticoids should be considered when associated with serious complications. The 595 nm PDL is effective in managing superficial vascular malformations in childhood, and could attempt to increase the treatment times to improve the outcomes.
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Affiliation(s)
- Bin Yang
- From Department of Dermatology, Beijing Children's Hospital, Capital Medical University, Beijing, China (BY, LL, L-xZ, Y-jS, LM)
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Tajima S, Takanashi Y, Koda K. Enlarging cystic lymphangioma of the mediastinum in an adult: is this a neoplastic lesion related to the recently discovered PIK3CA mutation? INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:5924-5928. [PMID: 26191320 PMCID: PMC4503191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/14/2015] [Indexed: 06/04/2023]
Abstract
Cystic lymphangioma, a lymphatic system malformation, is usually observed in infants and children and is rarely found in adults. It most commonly occurs in the cervicofacial region, followed by the axilla. Mediastinal cystic lymphangioma is rare, accounting for 1.8% of all mediastinal cysts. Herein, we present an exceedingly rare adult case of mediastinal cystic lymphangioma that had increased in size over a 5-year period. Although fluid collection might be an alternative explanation for this increase in size, this lymphangioma might harbor a neoplastic nature related to the recently discovered PIK3CA mutation.
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Affiliation(s)
- Shogo Tajima
- Department of Pathology, Shizuoka Saiseikai General HospitalShizuoka, Japan
| | - Yusuke Takanashi
- Department of Chest Surgery, Fujieda Municipal General HospitalShizuoka, Japan
| | - Kenji Koda
- Department of Pathology, Fujieda Municipal General HospitalShizuoka, Japan
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45
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Misra SR, Rastogi V, Mohanty N, Vineet DA. Locally aggressive cavernous haemangioma of the mandible: an unusual presentation. BMJ Case Rep 2015; 2015:bcr-2014-208975. [PMID: 25819825 DOI: 10.1136/bcr-2014-208975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Satya Ranjan Misra
- Institute of Dental Sciences, Siksha O' Ansuandhan University, Bhubaneswar, Odisha, India
| | - Varun Rastogi
- Department of Oral Pathology & Microbiology, Kalka Dental College, Meerut, Uttar Pradesh, India
| | - Neeta Mohanty
- Department of Oral Pathology & Microbiology, Institute of Dental Sciences, Siksha O' Ansuandhan University, Bhubaneswar, Odisha, India
| | - Daniel Alex Vineet
- Department of Oral Medicine & Radiology, PMS College of Dental Science & Research, Thiruvananthapuram, Kerala, India
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Hogendoorn W, Lavida A, Hunink MGM, Moll FL, Geroulakos G, Muhs BE, Sumpio BE. Open repair, endovascular repair, and conservative management of true splenic artery aneurysms. J Vasc Surg 2014; 62:1667-76. [PMID: 25264364 DOI: 10.1016/j.jvs.2015.08.052] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 08/03/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE True splenic artery aneurysms (SAAs) are a rare but potentially fatal pathology. For many years, open repair (OPEN) and conservative management (CONS) were the treatments of choice, but throughout the last decade endovascular repair (EV) has become increasingly used. The purpose of the present study was to perform a systematic review and meta-analysis evaluating the outcomes of the three major treatment modalities (OPEN, EV, and CONS) for the management of SAAs. METHODS A systematic review of all studies describing the outcomes of SAAs treated with OPEN, EV, or CONS was performed using seven large medical databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to ensure a high-quality review. All articles were subject to critical appraisal for relevance, validity, and availability of data regarding characteristics and outcomes. All data were systematically pooled, and meta-analyses were performed on several outcomes, including early and late mortality, complications, and number of reinterventions. RESULTS Original data of 1321 patients with true SAAs were identified in 47 articles. OPEN contained 511 patients (38.7%) in 31 articles, followed by 425 patients (32.2%) in CONS in 16 articles and 385 patients (29.1%) in EV in 33 articles. The CONS group had fewer symptomatic patients (9.5% vs 28.7% in OPEN and 28.8% in EV; P < .001) and fewer ruptured aneurysms (0.2% vs 18.4% in OPEN and 8.8% in EV; P < .001), but no significant differences were found in existing comorbidities. CONS patients were usually older and had smaller-sized aneurysms than patients in the OPEN and EV groups. The only identified difference in baseline characteristics between OPEN and EV was the number of ruptured aneurysms (18.4% vs 8.8%; P < .001). OPEN had a higher 30-day mortality than EV (5.1% vs 0.6%; P < .001), whereas minor complications occurred in a larger number of the EV patients. EV required more reinterventions per year (3.2%) compared with OPEN (0.5%) and CONS (1.2%; P < .001). The late mortality rate was higher in patients treated with CONS (4.9% vs 2.1% in OPEN and 1.4% in EV; P = .04). CONCLUSIONS EV of SAA has better short-term results compared with OPEN, including significantly lower perioperative mortality. OPEN is associated with fewer late complications and fewer reinterventions during follow-up. Patients treated with CONS showed a higher late mortality rate. Ruptured SAAs are predictors of a significantly higher perioperative mortality compared with nonruptured SAAs in the OPEN and EV groups.
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Affiliation(s)
- Wouter Hogendoorn
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn; Section of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
| | - Anthi Lavida
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn; Department of Vascular Surgery, Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - M G Myriam Hunink
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Health Policy & Management, Harvard School of Public Health, Boston, Mass
| | - Frans L Moll
- Section of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
| | - George Geroulakos
- Department of Vascular Surgery, Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - Bart E Muhs
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn
| | - Bauer E Sumpio
- Section of Vascular Surgery, Yale University School of Medicine, New Haven, Conn.
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