Presentation
Thoracic wall deformity. Hemangioma?
Patient Data
Longitudinal image of the ultrasound at the site of deformity.
It shows a partly hyperechoic lesion containing many tortuous vessels (much less than 6 vessels/cm2 as expected in hemangioma). There was a very slow venous flow in these vessels on Doppler imaging (not shown here).
This is highly suggestive of a venolymphatic malformation, but MRI is suggested to further evaluate this malformation.
MRI confirms the presence of a voluminous lesion involving the anterior right thoracic wall. It creates an imprint on the liver without invading it, and a very small part of the lesion invades the pleura.
The lesion is hypervascular and contains many small & tortuous vessels, without flow voids, confirming the slow flow detected on the Doppler evaluation. It also has many small enhancing septations. It is mainly iso- to hypo-intense on T1, hyperintense on T2 & T2 fat-sat. However, there are no fluid-fluid levels.
A simple hemangioma would enhance more diffusely. It would also contain flow-voids and it is classically polylobulated. The presence of septations & tortuous slow-flow veins makes venolymphatic malformation the most plausible hypothesis.
Case Discussion
This case was later confirmed to be a venolymphatic malformation. The patient was treated with percutaneous sclerotherapy.
The main differential diagnosis includes: sarcoma, plexiform neurofibroma & teratoma.
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