Venous malformation phleboliths mimicking submandibular sialadenitis in children

To report one paediatric patient who presented with a rare venous vascular malformation as a mass in the left submandibular region with a clinical picture compatible with sialadenitis. Phleboliths are a specific feature of venous malformations due to venous stasis and may mimic sialoliths on various imaging modalities. Thus venous malformations are often misdiagnosed as sialadenitis due to sialolithiasis. Sialoliths are extremely rare in paediatric patients. In an early adolescent presenting with a submandibular mass and suspected sialadenitis arising from sialoliths, a detailed history, clinical examination and careful review of the radiological findings will allow the diagnosis of venous vascular malformation and provide the complete surgical resection. Our patient was initially referred with a presumed diagnosis of submandibular sialadenitis, and instead a venous malformation with phlebolith was diagnosed.

3D printing personalized guide plate in the management of recurrent intramuscular venous malformations: A single center experience

Objective

This study aimed to investigate the feasibility and effectiveness of 3D printing personalized guide plate in the management of recurrent intramuscular venous malformations (IVM).

Methods

Fifteen patients with recurrent IVM were retrospectively assessed. 3D-slicer software was used to extract and reconstruct the imaging data from CT and/or MRI to highlight the morphology, size, and puncture depth of the lesion. With the guidance of personalized plate, complete excision of the IVM was adopted along the pre-marked (methylene blue, MB) margin.

Results

Personalized guide plate matched involved extremity well, and MB-puncture approach was consistent with preoperative design. All IVMs were removed radically in one single session. Complete pain relief was obtained in all cases postoperatively.

Conclusion

The application of 3D printing guide plate can be safe, effective, and reliable to confirming the precise margin of IVM, renders a promising technique with a high practical value in resection of recurrent lesion.

Venous malformations: what do phleboliths tell us in the pediatric population?

PURPOSE

Phleboliths are often observed within Venous malformations (VM) and frequently indicated as cause of morbidity. The aim of this study is to investigate independent risk factors for phleboliths in a pediatric population and to determine if its presence influences clinical management.

METHODS

We retrospectively review data from patients diagnosed with VM in a vascular anomalies center during a 5-year period. Associations between phleboliths and potential risk factors were assessed. A multivariable analysis, was performed to assess the influence of phleboliths in the need for surgery.

RESULTS

We included 88 patients with a mean age of 10 years. Phleboliths were found in 33.0%. In univariate analysis, there were no significant differences between the two groups regarding age or gender, location, dimension or depth of the VM, pain and laboratory parameters. Multivariable analysis could not detect any independent risk factor for phleboliths. In contrast, multivariable logistic analysis revealed that when phleboliths were present, the need for surgical extirpation was more likely (p = 0.031).

CONCLUSIONS

This study showed that patients who have phleboliths within their VM seem to require surgery more frequently. This constitutes an entirely innovative thought that could raise awareness to a lower threshold for surgery in this group of patients.

How we approach localized vascular anomalies

Vascular anomalies are a group of disorders divided into two distinct subtypes: vascular tumors and vascular malformations. Vascular tumors are proliferative in nature, while malformations are nonproliferative. Simple, localized vascular malformations refer to a group of malformations that are localized to a single area of involvement. These simple malformations include capillary, lymphatic, venous, and arteriovenous malformations. The pediatric hematologists and oncologists are becoming increasingly involved in the diagnosis and management of these disorders. This review presents four cases as a means to discuss the diagnosis, clinical and imaging features, and management strategies of simple, localized vascular malformations.

Phleboliths of the Head and Neck Region - A Case Report

Rationale

Phleboliths are idiopathic calcifications resulting from mineralised structures inside veins, venules or blood vessels.

Patient Concerns

A 48-year-old woman presented with multiple hard bodies on palpation.

Diagnosis

Imaging studies revealed multiple, round, well-defined radiopaque lesions, extending from the coronoid process region down to the base of the mandible. The diagnosis was vascular malformation with multiple phleboliths.

Treatment and Outcome

No treatment was proposed and the patient is under follow-up.

Take-Away Lessons

Asymptomatic phleboliths of the head and neck region in an adult woman have been under surveillance.

Radiological evaluation of maxillofacial soft tissue calcifications with cone beam computed tomography and panoramic radiography

OBJECTIVE

We aimed to present the radiologic characteristics of maxillofacial soft tissue calcifications with a comparison of cone beam computed tomography (CBCT) and panoramic radiography (PR) findings.

MATERIALS AND METHODS

The study was based on CBCT images obtained for different purposes between October 2017 and September 2018. The absence, location and radiological characteristics of some calcifications were evaluated in 252 patients. Statistical analysis was performed with SPSS version 21.0; P < .05 was considered to indicate statistical significance.

RESULTS

Palatine tonsilloliths were the most common calcifications in our study. Calcifications were most frequent in the sixth decade of life. Women had larger calcifications than men. There was a relationship between the sizes measured by CBCT and PR for tonsilloliths. In PR, Region 2 had significantly more calcifications compared with the other regions. The C2 vertebral level was the most common region for tonsilloliths based on CBCT.

CONCLUSIONS

Tonsilloliths have a high prevalence. The regular peripheral type had a higher risk of being a tonsillolith in PR. The peripheral/internal characteristics and the dimensions of calcifications between the two imaging modalities were in harmony. The location of calcification in PR and CBCT was important to distinguish the type of calcification.

Localized intravascular coagulation in venous malformations: A system review

Venous malformation is one of the slow-flow vascular malformations. Dysfunction of coagulation often occurs in most venous malformations, especially the diffuse and multifocal lesions, referred to as localized intravascular coagulopathy. It is characterized by the elevation of D-dimers and fibrin degradation products, low levels of fibrinogen, FV, FVIII, FXIII, and antithrombin III, and sometimes minor-to-moderate thrombocytopenia. Here we reviewed the clinical manifestations, pathogenesis, diagnosis, and treatment of localized intravascular coagulopathy in venous malformations.

The Use of a Three-Dimensional Printed Model for Surgical Excision of a Vascular Lesion in the Head and Neck

Facial vascular lesions are considered a great therapeutic challenge due to the considerable variability of clinical presentations. Surgical removal requires precise planning and advanced visualization to understand the three-dimensional anatomical relationships better.The aim of the study was to evaluate the feasibility of three-dimensional printed models, based on computed tomography angiography (CTA), in planning and guiding surgical excision of vascular lesions.A patient with a suspected vascular malformation in the face was recruited for participation in this feasibility study. Two personalized three-dimensional models were printed based off 2 separate CTA examinations. These constructs were used in preoperative planning and navigating surgical excision. The three-dimensional constructs identified the vicinity of the lesion and highlighted significant anatomical structures including the infraorbital nerve and vessels supplying the area of vascular anomaly. On postoperative follow-up the patient reported no recurrence of swelling and no sensory deficits.A personalized three-dimensional printed model of a facial vascular lesion was developed based on CTA images and used in preoperative planning and navigating surgical excision. It was most useful in establishing dangerous areas during the dissection process, including critical anatomical structures such as the infraorbital nerve. Combining conventional imaging techniques with three-dimensional printing may lead to improved diagnosis of vascular malformations and should be considered a useful adjunct to surgical management.

Clinical significance of galectin-3 expression in malformed hepatic venous tissue

Background & objectives:

Hepatic venous malformation gradually develops over time and exhibits the malignant biological behaviours of being locally invasive, causing morphological and functional damage to local tissue, and may even cause systemic coagulopathy. Studies show that galectin-3(Gal-3) expression is closely associated with local invasion of malignant tumours. In this study an attempt was made to assess the clinical significance of Gal-3 in local invasion during hepatic venous malformation in patients.

Methods:

Gal-3 protein and its mRNA expression were examined using immunohistochemistry and in situ hybridization in a total of 126 patients with hepatic venous malformation. For control tissue, 20 cases of normal tissue distal to surgical margins were also examined. In addition, the association between Gal-3 expression and pathological parameters was analyzed in hepatic venous malformation patients.

Results:

Gal-3 mRNA positivity was observed in 65.08 per cent (82/126) of hepatic venous malformation tissue samples, which was higher than the rate of 20 per cent (4/20) (P<0.05) seen in control tissues. Gal-3 protein positivity was observed in 58.73 per cent (74/126) of hepatic venous malformation tissue samples, which was higher than the rate of 15 per cent (3/20) (P<0.05) seen in the normal tissue. Gal-3 expression was not significantly associated with age or gender. However, there was a significant association between Gal-3 positivity and lesion size, local invasion depth, and involvement with the hepatic vein and the portal system.

Interpretation & conclusions:

Local tissue invasion and destruction by hepatic venous malformation may be related to the upregulation of Gal-3. Gal-3 expression and the development of venous malformation may be related and needs to be studied further.

A Pearl-Like 30-Year-Old Moving Phlebolith in the Left Cephalic Vein

BACKGROUND

Phleboliths are a common finding, especially in the pelvic veins. There are generally multiple thrombi associated with vascular malformations, trauma, or iatrogenic or noniatrogenic intravenous foreign bodies.

METHODS

Herein, we report a unique case of a single moving phlebolith in the cephalic vein of a 65-year-old man, not associated with any vascular lesion, trauma, or foreign body.

RESULTS

Too many cases of phleboliths have been reported in the literature since 1948, referred to vascular disorders, injuries, or foreign bodies. Only this work we are presenting refers to a phlebolith not associated with other vascular, pathological, or traumatic lesion.

CONCLUSION

Phleboliths not associated with other vascular lesions are not common and less rare when not associated with injuries or iatrogenic interventions. Clinicians should be aware of the existence of this pathology and include it as the differential diagnosis of various pathological conditions.

Parapharyngeal Space Venous Malformation: An Imaging Mimic of Pleomorphic Adenoma

Venous malformations in the parapharyngeal space are rare and may be challenging to diagnose with imaging secondary to multiple overlapping features with pleomorphic adenoma, which is much more commonly found in this region. While both lesions are T1 isointense and T2 hyperintense relative to skeletal muscle and demonstrate contrast enhancement, more uniform T2 hyperintensity and progressive contrast pooling on delayed postcontrast T1WI may allow the radiologist to include venous malformation in the differential diagnosis. This is important because it has the potential to alter management from surgical resection to observation. The primary aim of this study was to review the imaging appearance of parapharyngeal venous malformations through a retrospective case series.

Risk factors associated with pain in patients with venous malformations of the extremities

Pain is a common symptom and the major complaint in patients with venous malformations of the extremities, which may lead to joint dysfunction and even walking disabilities. Therefore, this study aimed to investigate determined independent risk factors for pain in these patients. We retrospectively collected data for 168 patients with venous malformations of the extremities from January 16, 2013 to August 13, 2015. They were categorized into painful and painless groups according to the symptom and pain scores. Associations between pain and candidate factors were determined using univariate and multivariate analyses. A total of 125 (74.4%) patients with an average pain score of 4.4 were included in the painful group. In univariate analysis, age, lesion size, tissue involvement, and phleboliths were associated with pain. In the multivariate analysis, only type-II tissue involvement (adjusted odds ratio 4.57; p = 0.001) and phleboliths (adjusted odds ratio 2.44; p = 0.039) were identified as the independent risk factors. In conclusion, this study revealed that prevalence of pain in patients with venous malformations of the extremities was high. Patients who presented with type-II tissue involvement and phleboliths are more likely to suffer from pain.

Extracranial vascular malformations (hemangiomas and vascular malformations) in children and adolescents - diagnosis, clinic, and therapy

The field of extracranial vascular anomalies is considered as special focus of pediatric otolaryngology and it has shown a rapid development during the last years. The reason for this interest is finally also due to the global acceptance of the classification introduced by the ISSVA (International Society for the Study of Vascular Anomalies). Hemangiomas are the most frequently observed vascular tumors. Today the systemic propranolol therapy is mostly used for therapy of hemangiomas requiring treatment. Increasingly, the topical application of beta blocker is discussed while the benefit in the head and neck seems to be limited. Vascular malformations are classified according to the morphology of the affected part of the vascular system in arterial, venous, arterio-venous, lymphatic, capillary, and combined vascular malformations. Conventional surgery, sclerosing therapy, and laser treatment are invasive options for the treatment of lymphatic malformations. The options for the treatment of venous malformations could be significantly improved during the last years. In this context, the use of Nd:YAG laser, the conservative treatment of the localized disseminated intravascular coagulation with low-molecular weight heparin, the re-discovery of bleomycin as effective sclerosing agent, and the improvement of alcohol-based embolization agents must be mentioned. Today the treatment with dye laser is the preferred therapy for capillary malformations and it is superior to other therapeutic options as for example photodynamic therapy. Arterio-venous malformations as representatives for high-flow lesions are the high-risk lesions. Frequently they are compared to malignant head and neck tumors, in particular when a curative treatment can no longer be assured because of diffuse or multifocal extent and when the disease shows a progressive course. The combined treatment of embolization and surgical resection and if necessary consecutive defect reconstruction have turned out to be appropriate for arterio-venous malformations. Incurable findings are still a major challenge. Despite the introduction of antiangiogenetic drugs in oncology, the medicamentous therapeutic approach could not be established for arterio-venous malformations up to now.

[Venous and arteriovenous malformations in the head and neck region. Therapeutic options and challenges]

Venous malformations are the prototype low-flow malformations in the head and neck region. Arteriovenous malformations (AVM) represent the main high-flow malformations. In recent years it has been possible to significantly optimize the therapeutic options for venous malformations. In addition to conventional surgery, laser treatment and sclerotherapy have become established techniques and the importance of embolization with new alcohol-based materials is increasing. AVM are progressive and destructive diseases. Therapy of choice is usually a combined treatment comprising embolization and surgical removal of the arteriovenous nidus. This curative approach is usually possible if diagnosis is made at an early stage. Incomplete embolization or sole ligation of the arterial supply causes progression. There is a clear need for improved therapeutic methods and pharmacotherapeutic approaches.