Thrombosis in forearm vascular malformation

Case contributed by Chris O'Donnell
Diagnosis almost certain

Presentation

Long standing swelling of left forearm. Now painful lump.

Patient Data

Age: 15 years
Gender: Male

Vascular structure in the soft tissues containing a "filling defect" consistent with thrombus. 

MRI scan performed to better determine the cause of thrombosed "vein"; fish oil capsules used to demark the mass.

  • axial T1 the thrombosed vein is identified. Note diffuse soft tissue swelling on the radial side of the forearm together with increased fat in the plane between the brachioradialis and extensor carpi radialis muscles
  • axial T2 fat sat the thrombosed vein is seen but surrounded by other abnormal vessels containing "flow"
  • sagittal T1 it is apparent that there is a more extensive vascular lesion with local swelling of soft tissue including fat in and around the brachioradialis muscle
  • axial T2 fat sat  the extent of the abnormal vascularity is now evident, interestingly without phase-encoded flow artefact (as compared with the normal forearm vessels) suggesting that it is a "slow flow" lesion

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