Presentation
Asymmetry and pain in the lower limbs, enlarged and swollen right leg. History of amputation of the right foot due to necrosis.
Patient Data
At the iliac bifurcation, the left common iliac artery and its branches are of preserved calibers, where the common iliac measures 8.3 mm.
The left femoral, popliteal, tibiofibular trunk, peroneal, tibialis anterior, and tibialis posterior arteries retain their calibers and are patent following contrast administration.
The right common iliac artery and its branches are enlarged, measuring 17 mm and 11 mm, respectively.
The right iliac veins are also enlarged, without signs of thrombosis.
Multiple serpiginous vessels are seen in the right lower quadrant and extend throughout the entire voluminous right lower limb, compatible with arteriovenous malformation.
There is an increase in the volume of the affected right lower limb, with significant involvement of the hip. There is fatty replacement of the muscle in the leg.
Significant dilation of the superficial venous system.
Also, spontaneously hyperdense dispersed linear structures are identified, likely as a result of prior embolization.
On the bone window, involvement of the right iliac bone is observed, as in an important alteration of the density and morphology of the femoral head on this side and an alteration of the bone density of the femur, tibia, and fibula. The right femur is shorter compared to the left.
Retro-aortic left renal vein as an anatomical variant.
Case Discussion
Parkes Weber syndrome is a little-known and underdiagnosed entity. It is characterized by the presence of arteriovenous and lymphatic malformations (fistulas).
In our case, the patient presented with pain in the lower limbs, asymmetry thereof, and port wine colored skin spots.