Overlapping of Sturge Weber syndrome and Klippel Trenaunay Weber syndrome

Sturge-Weber Syndrome (SWS) occurs sporadically with a frequency of approximately 1 in 50,000. SWS is a mesodermal phakomatosis. Klippel-Trenaunay Weber syndrome (KTWS) is another very rare phakomatosis. Overlap between SWS & KTWS is very rarely encountered. We report a 19 months old boy with features of both SWS and KTWS. The reported case had seizures, port wine haemangioma of the right side of the body, glaucoma of both eyes, subcortical calcification which were consistent with the Sturge Weber Syndrome; on the other hand he had also hypertrophy of the right side of the including the face and limbs, angiomatous skin naevus, varicosities consistent with the KTWS.

An unusual case of Klippel-Trénaunay-Weber syndrome presenting with portosystemic encephalopathy

We report a unique male patient presenting with portosystemic encephalopathy (PSE) due to intrahepatic portohepatic venous (PHV) shunts. He was diagnosed as having Klippel-Trénaunay-Weber syndrome (KTWS) based on the findings of a hemitruncal port-wine stain with subcutaneous arteriovenous fistulae and varicose veins in the legs. However, limb-hypertrophy, which is one of the most cardinal manifestations of KTWS, was absent, and in KTWS, PSE is quite a rare clinical manifestation. Hence, the clinical picture of this patient was unusual. Our clinical observation suggests that KTWS can be one of the underlying disorders causing PSE.

Prenatal sonographic findings of Klippel-Trénaunay-Weber syndrome

We describe the prenatal sonographic findings in a case of Klippel-Trénaunay-Weber syndrome including fetal ascites and subcutaneous cystic lesions associated with a relatively low level of maternal serum alpha-fetoprotein and a relatively high level of maternal serum beta-human chorionic gonadotrophin. Klippel-Trénaunay-Weber syndrome may present prenatally with fetal ascites and an abnormal maternal serum screening result in addition to fetal limb hypertrophy and subcutaneous cystic lesions.

Linfangioma quístico esplénico en una paciente con síndrome de Klippel-Trenaunay-Weber. Hallazgos en la ecografía y la RM

We present the case of a 22-year-old woman with Klippel-Trenaunay-Weber syndrome who presented with clinical signs and symptoms of gastrointestinal obstruction. Ultrasonography and magnetic resonance imaging showed massive splenomegaly with multiple cysts replacing the normal parenchyma of the spleen. Histologic study after splenectomy confirmed the diagnosis of cystic lymphangioma of the spleen, which is an exceptional manifestation of Klippel-Trenaunay-Weber syndrome.

Catheter-directed thrombolysis and mechanical thrombectomy of a thrombosed persistent sciatic vein in a patient with Klippel-Trénaunay syndrome

The authors report a case of a thrombosed persistent sciatic vein in a patient with Klippel-Trénaunay syndrome diagnosed at magnetic resonance (MR) venography and its treatment with endovascular interventional techniques.

Klippel-Trenaunay syndrome: report of case affecting oral cavity

A patient is described with clinical characteristics suggesting a vascular syndrome that included an oral component. After an intraoral biopsy was taken and further evaluation performed, it was determined that the patient exhibited criteria consistent with Klippel-Trenaunay syndrome, a rare congenital vascular disorder.

Management of urethral hemangiomas associated with Klippel-Trenaunay-Weber syndrome by endoscopic sclerotherapy

Klippel-Trenaunay-Weber syndrome (KTS) is an unusual congenital anomaly characterized by cutaneous hemangiomas, varicosities and bony hypertrophy of the extremities. Herein the case is reported of a 24-year-old man with urethral bleeding from hemangiomas associated with KTS that were successfully managed by endoscopic sclerotherapy. A 23-G puncture needle was inserted into the bleeding vein to inject a 5% solution of monoethanolamine oleate (Oldamine), which is typically used for sclerotherapy of esophageal vasix. At a 4-month follow-up, the patient only had slightly bloodstained urethral discharge, and is doing well. This is the first case reporting endoscopic sclerotherapy for a KTS-associated urethral hemangioma.

Klippel-Trenaunay Syndrome: Incidence and Treatment of Genitourinary Sequelae

PURPOSE

Prior reviews regarding genitourinary manifestations of Klippel-Trenaunay syndrome used data acquired from diverse specialty specific articles to define the incidence and sequelae of its genitourinary manifestations. We believe that this resulted in erroneous conclusions regarding the urological complications of Klippel-Trenaunay syndrome.

MATERIALS AND METHODS

Data on genitourinary manifestations in patients with Klippel-Trenaunay syndrome treated at 1 institution from 1970 through 2005 were acquired.

RESULTS

Of 218 patients with Klippel-Trenaunay syndrome 30% (66 of 218) had genitourinary involvement, including 7% (15) with cutaneous genital abnormalities, 7% (15) with visceral genitourinary involvement and 16% (36) with each type. Intermittent bleeding from cutaneous genital abnormalities developed in 65% of patients (33 of 51). Conservative treatment with compression and/or cauterization was attempted in all 33 patients and it was successful in 64% (21 of 33). Intractable hemorrhage resulted in excision of the cutaneous bleeding site in 36% of cases (12 of 33). A total of 39 hospitalizations for gross hematuria occurred in 9% of the patients (19 of 218). Hematuria developed from the bladder in 11 cases, the urethra in 4 and the kidney in 4. Conservative therapy resolved gross hematuria in 21% of the patients (4 of 19). Refractory hematuria was successfully treated with cauterization in 37% of the patients (7 of 19) and by angiographic embolization in 10% (2 of 19). Intractable gross hematuria resulted in open surgical excision of the bleeding site in 32% of the patients (6 of 19).

CONCLUSIONS

The incidence of genitourinary manifestations of Klippel-Trenaunay syndrome is 30%, which is triple the previously reported incidence of 9%. Unlike prior reports stating that the genitourinary abnormalities rarely caused problems, 52% of the patients (34 of 66) with Klippel-Trenaunay syndrome who had urological manifestations eventually required interventional therapy for genitourinary complications.

Inverse Klippel-Trenaunay Syndrome: Review of Cases Showing Deficient Growth

BACKGROUND

Klippel-Trenaunay syndrome is defined by a coexistence of nevus flammeus and overgrowth of one or more limbs. Remarkably, however, deficient growth of an affected limb may likewise be noted.

OBSERVATIONS

We collected from the literature a number of cases of Klippel-Trenaunay syndrome associated with deficient growth such as shortening or hypoplastic muscle mass of the affected extremity.

DISCUSSION

The cause of the unusual deficient growth is unknown. Some patients may be compound heterozygotes carrying a 'plus' and a 'minus' allele at the responsible gene locus, and postzygotic recombination would give rise to two different cell clones homozygous for either allele.

CONCLUSION

In order to give a name to such paradoxical cases, we propose the term 'inverse Klippel-Trenaunay syndrome'.

Recombinant granulocyte-macrophage colony-stimulating factor in the treatment of indolent ulcers with Klippel-Trénaunay-Weber syndrome: a case report

Klippel-Trénaunay-Weber syndrome (KTWS) is a rare congenital disease characterized by cutaneous hemangiomata, venous varicosities and osseous soft tissue hypertrophy of the affected limb. We report a case of a patient with KTWS who had developed severe chronic, non-healing cutaneous ulcers resulting from several angiography procedures with embolization by various agents. The ulcers were treated with perilesional granulocyte-macrophage colony-stimulating-factor (GM-CSF) with gratifying results. This case report suggests that GM-CSF may enhance the healing of chronic wounds not responding to other treatment modalities in patients with congenital angiodystrophy syndromes, thus salvaging a limb from amputation.

Spinal arteriovenous malformations associated with Klippel-Trenaunay-Weber syndrome: a literature search and report of two cases

SUMMARY

Patients with Klippel-Trenaunay-Weber syndrome present with venous varices, cutaneous capillary malformations, and tissue hypertrophy, usually involving an extremity. A small but important subset also harbors arteriovenous malformations (AVMs) of the spine. We report 2 such cases, 1 with 3 concurrent spinal arteriovenous fistulas. These cases and our review of the literature emphasize the importance of screening the spine for AVMs. In addition, it is also important to investigate for the presence of multiple spinal AVMs.

Hemodynamic impairment, venous segmental disease, and clinical severity scoring in limbs with Klippel-Trenaunay syndrome

BACKGROUND

Klippel-Trenaunay syndrome (KTS) is a complex congenital anomaly featuring two or more of the following: (1) capillary malformations (port-wine stains), (2) soft tissue or bony hypertrophy (or both), and (3) varicose veins or venous malformations. With the purpose of determining the actual significance of venous impairment in patients with KTS, we quantified the venous valvular competency and calf muscle pump function and examined their effect on clinical severity.

METHODS

Included were patients with near-normal function of affected limb(s) and minimal/small foot hypertrophy. Excluded were those with deep venous hypoplasia, aplasia or thrombosis, lymphedema, limb length discrepancy (>2.5 cm), peripheral arterial (ankle-brachial index <1.0), or cardiac disease and walking impairment. Venous duplex scanning, ascending venography, magnetic resonance imaging, strain gauge plethysmography, and a bone scanogram were performed. We studied eight men and seven women aged 15 to 51 years (median, 24 years). The KTS involved 17 limbs (unilateral in 13 patients and bilateral in 2). Contralateral limbs in patients with unilateral KTS acted as controls (n = 13). Venous clinical severity was graded according to the CEAP and venous clinical severity score (VCSS), and reflux complexity was classified according to the venous segmental disease score. Outflow obstruction (outflow fraction at 1 and 4 seconds; OF(1) and OF(4), respectively), reflux (venous filling index), calf muscle pump function (ejection fraction), and hypertension (residual volume fraction) were determined in both limbs with strain gauge plethysmography. Data, reported as median and interquartile range, were analyzed with the Mann-Whitney test.

RESULTS

Varicose veins or venous malformations occurred in the medial, posterior, or anterolateral limb segments of the ankle (7/17, 7/17, and 9/17), calf (10/17, 8/17, and 12/17), knee (9/17, 8/17, and 8/17), and thigh (10/17, 6/17, and 8/17, respectively). Venous malformations occupied the subcutaneous space (17/17) and extended into the subfascial space in 6 (35.3%) of 17 limbs. Abnormal reflux (>0.5 seconds) was distributed in the great (64.7%; 11/17) and small (5.9%; 1/17) saphenous veins and the common femoral (23.5%; 4/17), femoral (41.1%; 7/17), popliteal (29.4%; 5/17), perforator (70.6%; 12/17), and axial calf (35.3%; 6/17) veins. There was no difference in the OF(1) and OF(4) between the affected limbs and the controls. Limbs with KTS had a fivefold greater venous filling index (0.133-0.46 mL . 100 mL(-1) . s(-1); 0.258 mL . 100 mL(-1) . s(-1)) than the controls (0.034-0.055 mL . 100 mL(-1) . s(-1); 0.046 mL . 100 mL(-1) . s(-1); P < .0001), and this was linked to a higher venous segmental disease score (3 [2-4] vs 0 [0-1]; P < .0001). Limbs with KTS had half the ejection fraction (20.8%; 12.3%-24%) of the controls (39.3%; 30.9%-64.6%) and twice as high a residual venous fraction (77% [69.6%-84.5%] vs 40.9% [20.6%-60%]; both P < .004). Patients complained of swelling (100%; 15/15), aching (100%; 15/15), pain (93.3%; 14/15) and heaviness (100%; 15/15), tiredness (66.7%; 10/15), and tightness (33.3%; 5/15) of the limb(s) with KTS. Limbs with KTS had a worse (1) venous clinical severity by 11 VCSS points (11 [8-12] vs 0 [0-1]) and (2) clinical status by 3 CEAP classes (C3 [C3-C4] vs C0 [C0-C2]) than the control limbs (both P < .0001).

CONCLUSIONS

Venous disease in limbs with KTS is a major source of morbidity in affected patients. Limbs with KTS are characterized by complex reflux patterns, severe valvular incompetence, calf muscle pump impairment, and venous hypertension, thus explaining the advanced clinical severity (VCSS) and CEAP grade.

Epulis granulomatosa as an oral manifestation of Klippel-Trénaunay syndrome

The Klippel-Trénaunay syndrome (KTS) was first described by Klippel and Trénaunay in 1900. It is characterized by the triad of hemihypertrophy of soft and hard tissue, naevus flammeus and venous varicosity in the affected area. Though all oral tissues may be affected, only 5% of KTS show manifestations in the head and neck region. Only three cases are described with an oral manifestation, showing gingival overgrowth clinically and histologically corresponding to a pyogenic granuloma. It is still uncertain whether the combination of gingival fibromatosis and KTS is significant or coincidental. We report about a 25-year-old patient with KTS and recidivous gingival fibromatosis, clinically and histologically corresponding to an epulis fibromatosa in a case report. It is suggested that this occurrence is significant.

Klippel-Trenaunay syndrome: an unusual cause of pulmonary embolism

A 36-year-old female patient was admitted to the emergency department of our hospital with symptoms and signs of pulmonary embolism. Further evaluation established the diagnosis and anticoagulant therapy was immediately started. Physical examination revealed left lower extremity edema, prominent varicose veins, greater length of the involved limb and a capillary malformation extending from the lower abdomen down to the left knee. The diagnosis of Klippel-Trenaunay syndrome (KTS) was suspected and a color duplex scan was next performed revealing derangements in the lower extremity venous system including deep venous thrombosis. KTS is a congenital anomaly characterized by capillary malformation, extensive varicosities and limb hypertrophy. Anomalies of the deep and perforator venous system coexist and predispose to thromboembolic events. Pulmonary embolism is infrequently encountered in the setting of this syndrome.