Thenar eminence arteriovenous malformation

Case contributed by Christof Igler

Presentation

Progressive livid swelling of thenar and thumb within hours. No elevation of inflammatory markers. No trauma or prior surgery.

Patient Data

Age: 25 years
Gender: Female

Soft-tissue swelling in the thenar region.

Dilated vessels in the thenar region with flow-voids. Diffuse edema and swelling of the thenar muscles.

Dilated vessels in the thenar region an the deep palmar arch due to arteriovenous shunting.

Case Discussion

Unilateral extremity swelling is a common emergency setting. The most common differential diagnoses include cellulitis, abscess, lymphedema, and venous thrombosis.

Due to an acute onset within hours, an inflammatory process was primarily suspected.

The key findings in the MRI were dilated vessels with extensive flow-voids. The CT shows extensive arteriovenous shunting.

Arteriovenous malformations (AVMs) can occur anywhere in the body but have a predilection towards the head and neck.  

All that is swollen and red is not an infection. 

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