Soft tissue venous malformations, commonly known as soft tissue haemangiomas, are a location-dependent benign vascular soft tissue tumour.
They are the most common angiomatous lesions and represent up to 7% of all benign soft-tissue tumours 2.
It is important to note that according to newer nomenclature (ISSVA classification of vascular anomalies) these lesions are merely known as slow flow venous malformations. Having said that, it is probably helpful in reports to include the word 'haemangioma' as this term is ubiquitous in the literature and most familiar to many clinicians. The remainder of this article uses the terms 'soft tissue haemangioma' and 'soft tissue venous malformation' interchangeably.
There may be a greater female predilection. In the paediatric population, haemangiomas tend to be the most frequently diagnosed soft-tissue neoplasm.
Soft tissue haemangiomas may be classified into five histological subtypes.
This classification is dependent on the predominant type of vascular channel identified within them:
- capillary: commonest type; tend to predominate in the paediatric population.
They can arise in various anatomic locations, including striated muscle, skin, subcutaneous tissue, and synovial tissue (synovial haemangioma).
Small lesions may be occult on plain film, while large lesions may show evidence of a focal soft tissue swelling +/- associated phleboliths.
Can have a variable appearance. Typically seen as an ill-defined or well-defined hypoechoic mass of heterogeneous echotexture with multiple cystic spaces within. On colour Doppler, there may be no detectable signal or only weak signal 13.
On unenhanced CT, it may appear as an ill-defined mass of similar attenuation to muscle. CT may also show the presence of associated phleboliths.
Haemangiomas are typically well-defined, lobulated and heterogeneous with no features of local invasion.
While many sequences show a rather heterogeneous signal mass certain signal characteristics tend to dominate.
- overall signal is often intermediate to slightly high (relative to skeletal muscle) 6
- some focal high signal areas may be present in a large proportion of lesions (up to 70% 5,9)
- T2: high signal intensity tends to dominate on T2-weighted images
- gradient echo: the presence of phleboliths may show blooming artifact 10
- T1 C+ (Gd): lesions show marked signal enhancement in parts of the areas, which were both of high and low T2 8
Some intramuscular haemangiomas may also be associated with atrophic changes in muscles.
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- 9. Griffin N, Khan N, Thomas JM et-al. The radiological manifestations of intramuscular haemangiomas in adults: magnetic resonance imaging, computed tomography and ultrasound appearances. Skeletal Radiol. 2007;36 (11): 1051-9. doi:10.1007/s00256-007-0375-6 - Pubmed citation
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- 14. Toprak H, Kiliç E, Serter A et-al. Ultrasound and Doppler US in Evaluation of Superficial Soft-tissue Lesions. J Clin Imaging Sci. 2014;4 (1): 12. doi:10.4103/2156-7514.127965 - Free text at pubmed - Pubmed citation
Vascular tumours and malformations
vascular malformations and tumours
- vascular tumours
- tufted angioma (with or without Kasabach Merritt syndrome)
- Kaposiform hemangioendothelioma (with or without Kasabach Merritt syndrome)
- spindle cell hemangioendothelioma
- other, rare hemangioendotheliomas
- dermatologic acquired vascular tumors
- slow flow vascular malformations
- capillary malformation (CM)
- venous malformation (VM)
- common sporadic venous malformation
cavernous venous malformation (cavernoma or cavernous haemangioma)
- cerebral cavernous venous malformation
- orbital cavernous venous malformation
- hepatic cavernous venous malformation (hepatic haemangioma)
- splenic cavernous venous malformation (splenic haemangioma)
- breast venous malformation (breast haemangioma)
- retroperitoneal venous malformation
- soft tissue venous malformation
- primary intraosseous venous malformation
- cardiac venous malformations
- cavernous venous malformation (cavernoma or cavernous haemangioma)
- Bean syndrome
- familial cutaneous and mucosal venous malformation
- glomuvenous malformation (glomangioma)
- Maffucci syndrome
- common sporadic venous malformation
- lymphatic malformation (LM)
- fast flow vascular malformations
- arterial malformation
- arterial malformation
- arteriovenous fistulae (with one or more shunts)
- arteriovenous malformations (with a nidus of multiple shunts)