Venous malformation with sclerotherapy

Case contributed by Dr Mohammed Alshammari

Presentation

Left arm swelling.

Patient Data

Age: 11 years
Gender: Female

X-ray: Lobulated soft tissue densities associated with phleboliths calcification within the left shoulder and along the anteriomedial aspect of the left forearm. The adjacent bone is normal.

MRI: There is a soft tissue swelling of the left upper limb with large ectatic veins extending from shoulder to wrist more in the lateral aspect. 

The arteries of the left upper limb from subclavian  down to distal radial and ulnar arteries are unremarkable.

All veins are dilated, bedded appearance with sac dilatation and fluid-fluid levels within the ectatic veins.

The adjacent bones are normal. 

Fluoroscopy

Sclerotherapy: The left proximal forearm, midarm, supraclavicular and posterior aspect of the shoulder regions were all targeted with needle injections done percutaneously under ultrasound guidance to ensure single vein wall entry.

Angiographic runs confirmed needle position. The injections were done under road map starting with polidocanol followed by bleomycin 5 minutes late. Total 15 ml of bleomycin and 6.5 ml of 3% polidocanol.

Post operatively there was no nerve, shin or muscle complications.

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Case information

rID: 16535
Case created: 25th Jan 2012
Last edited: 17th Dec 2015
Inclusion in quiz mode: Included

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