Presentation
Left foot swelling and pain
Patient Data
Radiographs show soft tissue swelling between the first, second, and third toes with multiple phleboliths. The proximal phalanx of the third shows a bony impression suggestive of chronic compression.
There is evidence of palmar and digital thickening and the presence of abnormal signal intensity of infiltrate, lobulated, and multiloculated shape soft tissue lesions in the plantar surface of the left foot. It extends between the phalanges and metatarsals reaching the dorsum of the foot and more precisely surrounding the second and third metatarsal bone. It is approximately 2.4 x 2.9 x 10.6 cm and it shows isointense signal on T1-weighted images and is hyperintense on T2 and STIR sequences. Abnormal high signal intensity also within the adjacent metatarsal bones, representing reactive bony changes. Features are highly suggestive of diffuse and extensor soft tissue venous malformation (hemangioma).
Case Discussion
The presence of soft tissue multiple phleboliths and well-defined calcifications on radiographs suggest soft tissue venous malformation (a.k.a. hemangioma) until proven otherwise.
Soft tissue venous malformations are benign vascular lesions. Most soft tissue venous malformations are seen in the pediatric population.
Acknowledgment: Ahmed Mostafa Hassan Wahdan MD, Radiologist/
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