Venolymphatic thoracic wall malformation

Case contributed by Dr Maxime St-Amant

Presentation

Thoracic wall deformity. Haemangioma?

Patient Data

Age: 3
Gender: Male
Modality: Ultrasound

Longitudinal image of the ultrasound at the site of deformity.

It shows a partly hyperechoic lesion containing many tortuous vessels (much less dans 6 vessels/cm2 as expected in haemangioma). 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 evalute this malformation.

Modality: MRI

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 haemangioma would enhance more diffusely. It would also contain flow-voids and it is classicaly 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.

Related article:

PlayAdd to Share

Case Information

rID: 19082
Case created: 5th Aug 2012
Last edited: 30th Jan 2016
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.