Slow flow vascular malformation

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

Swelling of the right cervicofacial region, highly vascularized on color Doppler (not shown).

Patient Data

Age: 16 months
Gender: Male

Large right cervicofacial soft tissue mass showing the following characteristics:

  • composed of numerous serpiginous vascular structures
  • displaying a low signal on T1, high signal on T2 and T2 fat sat with no restricted diffusion
  • vivid enhancement on the postcontrast sequences (dynamic sequences not performed) 
  • centered on the parotid space with extension to the following spaces:
    • parapharyngeal space compressing and displacing the oropharynx to the left
    • carotid space encasing the internal carotid artery up to its intracavernous segment as well as the ipsilateral internal jugular vein
    • submandibular space with involvement of the submandibular gland, and the right premandibular space, displacing the masseter muscle
    • infratemporal and pterygopalatine fossae
    • involvement of the medial pterygoid muscle
    • posterior cervical space displacing the SCM muscle
    • intraosseous extension of the temporal bone (mastoid and petrous parts)
    • pre-and retroauricular soft tissues

Case Discussion

MRI features of a large cervicofacial mass composed of numerous enhancing vascular structures with multidirectional extension highly suggestive of slow-flow vascular malformation.

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