Forearm venous malformation

Case contributed by Dr Huy Sruy

Presentation

A young lady with forearm swelling and pain.

Patient Data

Age: 18
Gender: Female
X-ray

The study reveals multiple round calcifications at the distal left forearm (phleboliths) suggestive of a vascular (venous) malformation.

MRI

There are 3 groups of serpiginous tubular T2/STIR hyperintense structures along the left distal radius, posterior to the distal interosseous membrane and posterior aspect of the radius.

Multiple low intensity punctuate intralesional T1 and T2 foci (phleboliths).

Peripheral lesional fat due to muscle atrophy secondary to chronic vascular insufficiency.

DSA (angiography)

The distal brachial angiogram shows the minimal staining at the left distal radius which is supplied by small branches of interosseus artery without a nidus or early opacification of draining vein. This suggests a venous malformation.

Direct percutaneous contrast Injection under ultrasound guidance reveals two lesions (one is located between radius and ulna and the other is superposing on the left distal radius). Contrast was filled into the venous pouch and small draining vein. The venous malformation type II is suggested.

A percutaneous injection was performed into the lesions with 1:1.5 ratio of glue and lipiodol mixture.

Post glue injection shows total occlusion of the venous malformation.

No immediate complication is noted.

Case Discussion

Venous malformations is the most common vascular malformation and classified as the slow flow malformation.

Arteriography and venography have no role in the evaluation of venous malformation. But the DPP (Direct Percutaneous Phlebography) is very important for characterizing venous malformations prior to treatment.

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Case information

rID: 59749
Published: 8th May 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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