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Yoon H, Jeon BJ, Sung JH, Baek SH. A Case of Focal Myopathy With Neuropathy Caused by Intramuscular Vascular Malformation. J Clin Neurol 2023; 19:315-317. [PMID: 37151143 PMCID: PMC10169917 DOI: 10.3988/jcn.2022.0472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/10/2023] [Accepted: 02/23/2023] [Indexed: 05/09/2023] Open
Affiliation(s)
- Hojin Yoon
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Byeong Jun Jeon
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Joo Hye Sung
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seol-Hee Baek
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
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Painful swelling of the arm due to a bizarre intramuscular vascular malformation. J Orthop Sci 2022; 27:504-507. [PMID: 31431314 DOI: 10.1016/j.jos.2019.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/23/2019] [Accepted: 07/24/2019] [Indexed: 11/22/2022]
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Laurian C, Cerceau P, Paraskevas N, Massoni C, Marteau V, Wassef M, Houdart E, Bisdorff A. Intramuscular venous malformations of the calf: Surgical treatment outcomes of 57 patients. Phlebology 2020; 35:597-604. [PMID: 32375603 DOI: 10.1177/0268355520920811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To report the outcomes of surgical treatment of calf intramuscular venous malformations (IMVMs) on pain, functional limitation, and quality of life. METHODS We retrospectively reviewed 57 consecutive patients who had surgery for IMVM of the posterior compartment of the leg between 2010 and 2015. Treatments were all done at a single institution. RESULTS Patients presented with pain (52), muscle contracture (14), or pulmonary embolism (4). Muscle involvement included the soleus muscle (n = 28, 49%), the gastrocnemius muscle (n = 25, 43%), and deep muscles (n = 4, 7%). Complete excision was possible in 52 patients (91%) and partial excision in 5 (9%). Thirty-five of 46 patients who had an MRI follow-up at six months had no residual venous malformation. At the final follow-up (mean 39 months), 32 of 40 patients seen had no residual pain and 37 had no residual functional impairment. CONCLUSION In cases where IMVM is located in one muscle in the leg, we demonstrated that surgery yielded improvement in pain, function, and quality of life.
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Affiliation(s)
- Claude Laurian
- Department of Vascular Surgery, Saint Joseph Hospital, Paris, France
| | - Pierre Cerceau
- Department of Vascular Surgery, Bichat Hospital, Paris, France
| | | | | | | | - Michel Wassef
- Department of Pathology, Lariboisiere Hospitals, Paris, France
| | - Emmanuel Houdart
- Department of Neuroradiology, Lariboisère Hospital, Paris, France
| | - Annouk Bisdorff
- Department of Neuroradiology, Lariboisère Hospital, Paris, France
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Intramuscular Venous Malformations of the Upper and Lower Limbs: Indications and Outcomes of Sclerotherapy. Cardiovasc Intervent Radiol 2018; 41:1505-1512. [PMID: 29850938 DOI: 10.1007/s00270-018-1997-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 05/21/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Multiple treatment options have been described for intramuscular venous malformations (VMs) of the limbs. At the current time, there are no clear management guidelines. The aim was to evaluate efficacy and safety of sclerotherapy in this type of VMs. MATERIALS AND METHODS This is a single-center, retrospective review of patients treated for extremity intramuscular VMs between January 2013 and June 2017. The primary outcomes were the improvement of symptoms self-assessed by questionnaires, and the reduction in VM size measured by magnetic resonance (MRI). RESULTS Sclerotherapy was performed in 81 patients with extremity intramuscular VMs. The sclerosing agent was ethanol in 46 cases (56.8%), polidocanol in 27 cases (33.3%), a combination of both in 8 cases (9.9%). The mean follow-up was 26 months (range 3-52). Overall quality of life was improved in 62 patients (76.5%). The postoperative MRI showed a minimum change of VM size in 68 patients (83.9%). A major complication (peripheral nerve injury) was observed in 1 case (1.2% of patients, 0.5% of procedures). Minor complications occurred in 9 cases (11.1% of patients, 4.1% of procedures). CONCLUSIONS Sclerotherapy is a low-invasive, effective and safe treatment for intramuscular VMs of the extremities. It induces a significant improvement in symptoms, also when the VM size is unchanged. LEVEL OF EVIDENCE Level 4, Case Series.
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Leonard L, Meyer HJ, Surov A. [Imaging characteristics of malignant and benign lesions of skeletal muscle]. Radiologe 2017; 57:1059-1070. [PMID: 29181716 DOI: 10.1007/s00117-017-0323-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
There are many different tumors and tumor-like lesions with variable biological behavior that may affect the skeletal musculature. The aim of this study was to review the different intramuscular lesions and to provide a classification based on their radiological patterns. Intramuscular lesions can present as solid, liquid, semiliquid or fat equivalent manifestations and also as diffuse muscle enlargement and muscle calcification. Additionally, lesions with mixed patterns of the aforementioned alterations can also occur. Benign and malignant muscle lesions can often manifest with identical radiological patterns, which is why a certain differentiation is often difficult. A systematic radiological description and when possible assignment with respect to etiology and dignity depending on the patient history is necessary in order to recommend a subsequent histological confirmation or to avoid unnecessary confirmation.
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Affiliation(s)
- L Leonard
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - H J Meyer
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - A Surov
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland.
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Chism CB, Crawford L, Tchakarov A, Al-Ibraheemi A, Beckmann NM. PTEN hamartoma of the soft tissue: the initial manifestation of an underlying PTEN hamartoma tumor syndrome in a 4-year-old female. Skeletal Radiol 2017; 46:1591-1595. [PMID: 28756566 DOI: 10.1007/s00256-017-2732-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 06/20/2017] [Accepted: 07/13/2017] [Indexed: 02/02/2023]
Abstract
A 4-year-old female was referred to pediatric orthopedic surgery for left leg pain and limping for 3 months following a motor vehicle collision. Recently, the patient's mother had noted left knee swelling and dragging of the left leg when walking. Past medical history was significant for hip dysplasia with slight leg length discrepancy. The patient was otherwise healthy. Physical examination was remarkable for left pre-patellar soft tissue fullness with normal range of motion. There was no warmth or tenderness. Subsequent ultrasound revealed a heterogeneous soft tissue mass superior and medial to the patella with a moderate degree of internal vascularity. MR exhibited a heterogeneous soft tissue mass with heterogeneous signal on both T1- and T2-weighted images centered within the vastus medialis obliquus muscle infiltrating the quadriceps tendon. Excisional biopsy was performed with a histopathologic diagnosis of fibroadipose tissue with anomalous vessels, suggestive of phosphatase and tensin homolog (PTEN) hamartoma of the soft tissue (PHOST). The patient was found to be positive for the PTEN gene mutation on genetic testing. The child was also determined to be macrocephalic, a major criterion for PTEN hamartoma tumor syndrome (PHTS). The geneticist advised the patient to undergo yearly physical examinations and early, routine surveillance for several malignancies occurring with PHTS. This case report presents the ultrasound and MRI appearance of a rare benign tumor typically appearing in pediatric patients. The strong association between PHOST and other soft tissue malignancies and the resulting need for life-long surveillance make PHOST an important pathology to recognize.
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Affiliation(s)
- Charles B Chism
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2.130B, Houston, TX, 77030, USA.
| | - Lindsay Crawford
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Amanda Tchakarov
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Alyaa Al-Ibraheemi
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicholas M Beckmann
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2.130B, Houston, TX, 77030, USA
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Wieck MM, Nowicki D, Schall KA, Zeinati C, Howell LK, Anselmo DM. Management of pediatric intramuscular venous malformations. J Pediatr Surg 2017; 52:598-601. [PMID: 27622586 DOI: 10.1016/j.jpedsurg.2016.08.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/05/2016] [Accepted: 08/21/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intramuscular venous malformations (VMs) are rare, but can be highly symptomatic. There are few reports on outcomes, particularly pain, functional limitations, and muscle contractures. We aimed to compare results of medical management, sclerotherapy, and surgical resection. METHODS We retrospectively reviewed 45 patients with an extremity or truncal intramuscular VM between June 2005 and June 2015 at a single institution. Outcomes were compared between treatment modalities with ANOVA and χ2 tests. RESULTS Six patients (13%) were treated with medical management, 4 (9%) with surgical resection, 23 (51%) with sclerotherapy, and 12 (27%) with both surgery and sclerotherapy. Sclerotherapy alone decreased pain in 72%. Only 20% of patients presented with muscle contracture. For these patients, 33% resolved with sclerotherapy, physical therapy, and aspirin; 22% resolved with surgery, and 45% had persistent contracture. 40% of patients treated with sclerotherapy then surgery developed new muscle contractures, compared to 4% of sclerotherapy only patients and 0% of surgery only patients (p=0.04). CONCLUSIONS Medical management, surgery and sclerotherapy are effective treatments for intramuscular VMs. Observation and supportive care can be a primary treatment for patients with minimal symptomatology and no functional limitations. Sclerotherapy is more effective for treating pain than contractures and when used alone, rarely causes a new muscle contracture.
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Affiliation(s)
- Minna M Wieck
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Donna Nowicki
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Kathy A Schall
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Chadi Zeinati
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Lori K Howell
- Department of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Dean M Anselmo
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
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Low-Flow Vascular Malformation Pitfalls: From Clinical Examination to Practical Imaging Evaluation--Part 2, Venous Malformation Mimickers. AJR Am J Roentgenol 2016; 206:952-62. [PMID: 26999647 DOI: 10.2214/ajr.15.15794] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The purpose of this article is to review the unusual clinical and radiographic features of venous malformations that can give rise to diagnostic confusion. Entities that can have overlapping clinical and imaging features with venous malformations are also reviewed. CONCLUSION Venous malformations are congenital endothelial malformations secondary to errors in vascular morphogenesis and are usually diagnosed in the first 2 decades of life. The clinical and imaging features of venous malformations often overlap those of other pathologic entities, creating diagnostic confusion. Furthermore, the clinical presentation and imaging appearance of venous malformations can vary, making the diagnosis challenging. Thorough knowledge of the various clinical and imaging features not only of venous malformations but also of the major potential mimic lesions is crucial for clinicians caring for patients with these lesions.
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Abstract
There are several tumors and tumorlike conditions with variable biological behavior that may involve the skeletal musculature. The aim of this work was to review different intramuscular lesions and to provide a classification of muscle lesions based on their radiological patterns as well as to provide as a pictorial essay the imaging characteristics of typical muscle lesions. Radiologically, intramuscular lesions can manifest as solid masses, liquid or semiliquid masses, fat-containing lesions, diffuse muscle enlargement, and muscle calcifications. Additionally, lesions with mixed patterns can also occur. It is noteworthy that different malignant or benign muscle lesions can manifest with identical radiological patterns.
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Affiliation(s)
- Alexey Surov
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
| | - Marc-André Weber
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
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Vogel SA, Hess CP, Dowd CF, Hoffman WY, Kane AJ, Rajaii R, Frieden IJ. Early versus later presentations of venous malformations: where and why? Pediatr Dermatol 2013; 30:534-40. [PMID: 23679583 DOI: 10.1111/pde.12162] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Venous malformations (VMs) are congenital anomalies of the venous vasculature, but not all are evident at birth. The factors that lead to presentation later in life are not well understood. The objective of this retrospective cohort study of patients with VMs evaluated at the University of California at San Francisco Birthmarks and Vascular Anomalies Center from 2005 to 2009 was to investigate the clinical presentation of VMs and correlate these features with different types of tissues (e.g., skin, subcutis, intramuscular). Main outcomes included the age at which lesions were first noticed, tissue type involved, presenting signs and symptoms, aggravating factors, and morbidities. A total of 115 subjects was included. The mean age when VM was first noted was 6.7 ± 0.9 years. Tissue types involved included skin/subcutaneous (46%); intramuscular (40%); and bone, tendon, or joint (14%). Presenting signs/symptoms included soft tissue swelling (44%), discrete mass (34%), pain (33%), and skin discoloration (26%). When compared with VMs limited to the skin or subcutis, those restricted to the intramuscular compartment were less likely to present at birth (27% vs 53%, p < 0.05) but were more frequently painful (79% vs 60%, p < 0.05) and contained more phleboliths (28% vs 11%, p < 0.05), and were associated with more exercise limitation (35% vs 16%, p < 0.05). VMs differ in age of onset, clinical features, and complications based on differing tissues and sites of involvement, with isolated intramuscular involvement associated with later presentation and greater morbidity.
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Affiliation(s)
- Sinae A Vogel
- School of Medicine, University of California, San Francisco, San Francisco, California
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Wilmanska D, Antosik-Biernacka A, Przewratil P, Szubert W, Stefanczyk L, Majos A. The role of MRI in diagnostic algorithm of cervicofacial vascular anomalies in children. Pol J Radiol 2013; 78:7-14. [PMID: 23807878 PMCID: PMC3693840 DOI: 10.12659/pjr.883941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 01/28/2013] [Indexed: 11/30/2022] Open
Abstract
Background: Vascular anomalies are usually diagnosed through their clinical picture and history. The purpose of this study was to assess the role of MR imaging in initial assessment of cervicofacial vascular anomalies in children. Material/Methods: Twenty pediatric patients with vascular anomalies located in the cervicofacial region underwent MRI examination in our department. Images were evaluated for lesion detectability and its signal characteristics (on T1w, T2w images with fat suppression and contrast enhanced T1w sequences); the extent of the lesions and surrounding tissue involvement were also assessed. Results: In the studied group MR images revealed all anomalies and provided information of their anatomic extent and invasion of surrounding anatomic structures. Nine hemangiomas and six venous malformations were found among studied patients. Two children had multiloculated lesions corresponding to lymphatic malformations. One examination visualized a lesion consisting mainly of dilated vascular channels with an apparent feeding artery, which was consistent with arteriovenous malformation. Two remaining lesions were mixed malformations. Nine patients had lesions limited to subcutaneous tissue. Two masses infiltrated bone structures. There was muscle involvement found in nine cases. Conclusions: MR imaging is a well-established method for detection and monitoring of vascular anomalies in children. With ultrasound used mostly for initial diagnosis and additional flow assessment, angiography viewed as an invasive therapeutic method and computed tomography used only in specific situations due to its high irradiation dose, magnetic resonance is the best imaging method used in differential diagnosis and topographical characterization of vascular malformations and tumors of cervicofacial area in pediatric patients. Noninvasively and without irradiation, it enables evaluation of the extent and characteristics of lesions and planning proper therapeutic strategy.
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Affiliation(s)
- Dagmara Wilmanska
- Department of Radiology and Imaging Diagnostics, Medical University of Łódź, Łódź, Poland
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Efficacy of percutaneous ethanol sclerotherapy for venous malformation in lower extremities: a retrospective review of 21 cases. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-012-0754-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mostardi PM, Young PM, McKusick MA, Riederer SJ. High temporal and spatial resolution imaging of peripheral vascular malformations. J Magn Reson Imaging 2012; 36:933-42. [PMID: 22674646 DOI: 10.1002/jmri.23714] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 04/30/2012] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To assess the performance of a recently developed 3D time-resolved CE-MRA technique, Cartesian Acquisition with Projection-Reconstruction-like sampling (CAPR), for accurate characterization and treatment planning of vascular malformations of the periphery. MATERIALS AND METHODS Twelve patient studies were performed (eight female, four male; average age, 33 years). The protocol consisted of three-dimensional (3D) time-resolved CE-MRA followed by a single late phase T1-weighted acquisition. Vascular malformations were imaged in the forearm, hand, thigh, and foot. Imaging evaluation was performed for accurate characterization of lesion type, identification of feeding and draining vessels, involvement with surrounding tissue, overall quality for diagnosis and treatment planning, and correlation with conventional angiography. RESULTS Time-resolved CE-MRA allowed for characterization of malformation flow and type. Feeding and draining vessels were identified in all cases. Overall quality for diagnosis and treatment planning was 3.58/4.0, and correlation with conventional angiography was scored as 3.89/4.0. CONCLUSION The CAPR time series has been shown to portray the temporal dynamics and structure of vascular malformations as well as the normal vasculature with high quality. CAPR time-resolved imaging is able to accurately characterize high and low flow lesions, allowing for pretreatment lesion assessment and treatment planning. Delayed imaging is important to capture complete filling of very slow flow vascular malformations.
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Silva VA, Lima NL, Mesquita ATM, da Silveira EM, Verli FD, de Miranda JL, Santos CRR, Marinho SA. Intramuscular hemangioma in lip treated with sclerotherapy and surgery. Case Rep Dent 2011; 2011:302451. [PMID: 22567433 PMCID: PMC3335477 DOI: 10.1155/2011/302451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 06/12/2011] [Indexed: 11/20/2022] Open
Abstract
Intramuscular hemangioma is a relatively rare, benign tumor of vascular origin, accounting for less than 1% of all hemangiomas. This paper reports a case of a 48-year-old female patient with intramuscular hemangioma in the upper lip, treated with sclerotherapy and subsequent complementary surgery.
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Affiliation(s)
- Vanessa A. Silva
- School of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys (UFVJM), 39100-000 Diamantina, MG, Brazil
| | - Nádia L. Lima
- Laboratory of Pathology, Department of Basic Sciences, Federal University of Jequitinhonha and Mucuri Valleys (UFVJM), 39100-000 Diamantina, MG, Brazil
| | - Ana Terezinha M. Mesquita
- Laboratory of Pathology, Department of Basic Sciences, Federal University of Jequitinhonha and Mucuri Valleys (UFVJM), 39100-000 Diamantina, MG, Brazil
- Stomathology Clinics, School of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys (UFVJM), 39100-000 Diamantina, MG, Brazil
| | - Esmeralda Maria da Silveira
- Stomathology Clinics, School of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys (UFVJM), 39100-000 Diamantina, MG, Brazil
| | - Flaviana D. Verli
- Laboratory of Pathology, Department of Basic Sciences, Federal University of Jequitinhonha and Mucuri Valleys (UFVJM), 39100-000 Diamantina, MG, Brazil
| | - João Luiz de Miranda
- Laboratory of Pathology, Department of Basic Sciences, Federal University of Jequitinhonha and Mucuri Valleys (UFVJM), 39100-000 Diamantina, MG, Brazil
| | - Cássio Roberto R. Santos
- Stomathology Clinics, School of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys (UFVJM), 39100-000 Diamantina, MG, Brazil
| | - Sandra A. Marinho
- Stomathology Clinics, School of Dentistry, Federal University of Jequitinhonha and Mucuri Valleys (UFVJM), 39100-000 Diamantina, MG, Brazil
- Post Graduate Program in Dentistry, Federal University of Jequitinhonha and Mucuri Valleys (UFVJM), Rua da Glória 187, 39100-000 Diamantina, MG, Brazil
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Pretreatment Evaluation of Peripheral Vascular Malformations Using Low-Dose Contrast-Enhanced Time-Resolved 3D MR Angiography: Initial Results in 22 Patients. AJR Am J Roentgenol 2011; 196:702-11. [DOI: 10.2214/ajr.10.5092] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Madhusudhan KS, Sharma R, Kandpal H, Kumar A, Gamanagatti S, Jain V, Chumber S. A rare case of combined soft-tissue and intraosseous arteriovenous malformation of the hand with diffuse periosteal elevation: imaging appearances. Br J Radiol 2009; 82:e219-24. [PMID: 19890114 DOI: 10.1259/bjr/88504406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Arteriovenous malformations are uncommon congenital lesions of the hand. Although present at birth, they usually manifest later in life. Ultrasonography, MRI and digital subtraction angiography play an important role in the diagnosis of these lesions. We report the imaging appearances of an unusual case of combined soft-tissue and intraosseous arteriovenous malformation (AVM) of the hand with marked periosteal elevation in a 12-year-old child. Although associated skeletal changes are common, diffuse periosteal elevation owing to direct communication of the AVM with the subperiosteal space has not, to the best of our knowledge, been reported previously.
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Affiliation(s)
- K S Madhusudhan
- Departments of Radiodiagnosis Surgery, All India Institute of Medical Sciences, New Delhi - 110029, India
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Muchemwa FC, Ishihara T, Matsushita S. Intramuscular venous malformation in the upper arm with gross calcifications and compression of the ulnar nerve. ACTA ACUST UNITED AC 2009; 41:93-5. [PMID: 17605443 DOI: 10.1080/02844310600699432] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We report an unusual case of intramuscular venous malformation with calcifications that presented with features of involvement of the ulnar nerve.
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Affiliation(s)
- Faith C Muchemwa
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Japan
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Griffin N, Khan N, Thomas JM, Fisher C, Moskovic EC. The radiological manifestations of intramuscular haemangiomas in adults: magnetic resonance imaging, computed tomography and ultrasound appearances. Skeletal Radiol 2007; 36:1051-9. [PMID: 17849114 DOI: 10.1007/s00256-007-0375-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Revised: 08/02/2007] [Accepted: 08/11/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Intramuscular haemangiomas in adults may appear similar to soft tissue sarcomas on imaging. This study evaluates the imaging characteristics of intramuscular haemangiomas on magnetic resonance imaging (MRI), computed tomography (CT) and ultrasound. SUBJECTS AND METHODS Retrospective review of medical records, imaging and pathology details of 34 patients presenting with intramuscular haemangiomas was performed. Age of patient, size, site of lesion and type of imaging was recorded. Lesions were evaluated for calcification, presence of fat, outline, texture, vascularity, enhancement and involvement of local structures. RESULTS There were 12 male and 22 female patients aged between 9 years and 90 years (mean 39 years). Twenty-two lesions involved muscles of the extremities and 12 involved muscles of the trunk. Mean duration of the lesions was long: 59.3 months (range 3-240 months), with an average size of 7.5 cm (1.5-15 cm). Imaging comprised 27 MR studies, seven CT scans, 19 ultrasounds, and eight plain films. All lesions were well defined, lobulated and heterogeneous. None showed local invasion. On MRI and CT, 93-100% showed the presence of fat and 100% showed vascular channels and enhancement on MRI, CT and ultrasound. Phleboliths were seen on four plain films (50%) and on the corresponding MR images. On MRI, 70% of lesions had mildly hyperintense signal on T1-weighted sequences and 96% had hyperintense signal on T2-weighted sequences (relative to skeletal muscle). Histopathology confirmed diagnosis in all cases, showing the presence of fat, medium/large vessels and skeletal muscle. CONCLUSION Intramuscular haemangiomas have characteristic appearances on MRI, CT and ultrasound. Long history, presence of fat, calcification and internal vessels should alert the radiologist to this diagnosis prior to biopsy.
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Affiliation(s)
- N Griffin
- Department of Diagnostic Imaging, Royal Marsden Hospital, 203 Fulham Road, London SW3 6JJ, UK.
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Goodwin RW, O'Donnell P, Saifuddin A. MRI appearances of common benign soft-tissue tumours. Clin Radiol 2007; 62:843-53. [PMID: 17662731 DOI: 10.1016/j.crad.2007.04.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Revised: 03/05/2007] [Accepted: 04/27/2007] [Indexed: 02/07/2023]
Abstract
Benign soft-tissue tumours are many times more common than their malignant counterparts, and magnetic resonance imaging (MRI) is the technique of choice for imaging the lesions. This review illustrates the MRI appearances of the most common benign soft-tissue tumours, based on consecutive referrals to our institution. The imaging signs that are useful for diagnosis are described.
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Affiliation(s)
- R W Goodwin
- Department of Radiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
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22
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Abstract
Intramuscular hemangioma, an infrequent but important cause of musculoskeletal pain, is often difficult to establish the diagnosis clinically. This report describes a case of a 32-yr-old woman who presented with severe left calf pain for 10 yr. Initial conservative treatments consisting of intramuscular electrical stimulation, herb medication, acupuncture, and intramuscular lidocaine injection under the diagnosis of myofascial pain syndrome in other facilities, failed to alleviate the symptoms. On physical examination, there was no motor weakness or sensory change. Conventional radiography of the leg revealed a soft tissue phlebolith. Conventional angiography study showed hemangioma. Intramuscular hemangioma within the soleus muscle was confirmed by magnetic resonance imaging. Following surgical excision of the hemangioma, the patient's symptom resolved completely. Intramuscular hemangioma is a rare cause of calf pain and should be considered in the differential diagnosis if a patient with muscle pain, particularly if associated with a soft tissue mass, fails to respond to conservative treatment.
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Affiliation(s)
- Dong Hwee Kim
- Department of Physical Medicine & Rehabilitation, Korea University College of Medicine, Ansan Hospital, 516 Gojan-dong, Danwon-gu, Seoul, Korea.
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Fayad LM, Fayad L, Hazirolan T, Bluemke D, Mitchell S. Vascular malformations in the extremities: emphasis on MR imaging features that guide treatment options. Skeletal Radiol 2006; 35:127-37. [PMID: 16447042 DOI: 10.1007/s00256-005-0057-1] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2005] [Revised: 10/25/2005] [Accepted: 10/27/2005] [Indexed: 02/02/2023]
Abstract
Vascular malformations can be classified into high-flow arteriovenous malformations (AVM) and low-flow venous or lymphatic malformations (VM/LM). VMs and LMs have the ability to cross multiple tissue boundaries. Not only is subcutaneous tissue often involved, but multiple muscle groups, tendons, bone cortex and bone marrow are also not uncommonly violated. Magnetic resonance imaging (MRI) provides valuable information for the assessment and treatment of malformations. Firstly, MRI can characterize the flow pattern of these malformations to guide treatment towards trans-arterial embolization for AVMs and percutaneous embolization for low flow malformations. MRI is essential to define the anatomic extent and involvement of various tissue layers (a distinct advantage over ultrasound), and to correlate treatable components of the malformation with patient symptoms. Treatment is decided by the need to alleviate clinical symptoms, and is dependent on the extent of the malformation as defined by MRI. We present MRI features of vascular malformations to demonstrate the potential spectrum of involvement of these lesions, illustrating the value of MRI in treatment planning.
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Affiliation(s)
- Laura M Fayad
- Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
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24
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Drapé JL, Feydy A, Guerini H, Desmarais E, Godefroy D, Le Viet D, Chevrot A. Vascular lesions of the hand. Eur J Radiol 2005; 56:331-43. [PMID: 16298677 DOI: 10.1016/j.ejrad.2005.03.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Revised: 03/10/2005] [Accepted: 03/15/2005] [Indexed: 11/23/2022]
Abstract
The vascular malformations are not uncommon on the hand and offer diagnostic and therapeutic challenges. Enjolras and Mulliken's classification is exposed. Their depiction and pretreatment assessment may benefit from non-invasive imaging as color-Doppler ultrasound and MRI combined with magnetic resonance angiography (MRA). Some chronic traumatic vascular injuries as the hypothenar hammer syndrome may also take advantage of these imaging modalities.
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Affiliation(s)
- Jean-Luc Drapé
- Service de Radiologie B, Hôpital Cochin, APHP, Université Paris, 27 rue du Fbg Saint-Jacques, 75014 Paris, France.
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25
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Zimmerman SL, Moroz LA, Guttenberg ME, Dormans JP. Right knee pain in a 13-year-old boy. Clin Orthop Relat Res 2005:277-83. [PMID: 15805969 DOI: 10.1097/01.blo.0000160001.68887.f6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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26
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Herdman G, Dussa CU, Watura R, Cobby M. Intra-articular arteriovenous malformation of the knee. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2004. [DOI: 10.1007/s00590-004-0203-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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27
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Vilanova JC, Barceló J, Villalón M. MR and MR angiography characterization of soft tissue vascular malformations. Curr Probl Diagn Radiol 2004; 33:161-70. [PMID: 15306760 DOI: 10.1016/j.cpradiol.2004.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hemangioma is an abnormal proliferation of blood vessels that may occur in any vascularized tissue. Different classifications separate vascular lesions of soft tissues into hemangiomas and vascular malformations on the basis of their natural history, location, cellular turnover, and histology. Soft-tissue vascular malformations are relatively common. These lesions can be categorized on MR imaging because of their typical appearance as multiple lobules with fat overgrowth and serpentine channels, depending on the vascular flow. The combination of conventional MR and MR angiography (MRA) enable the differentiation between low-flow and high-flow vascular malformations and allows a noninvasive diagnostic strategy. This article reviews the MR and MRA imaging characteristics of soft-tissue hemangiomas to provide a helpful guide for radiologists to perform a more specific diagnosis and better management of these anomalies.
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Affiliation(s)
- Joan C Vilanova
- Department of Magnetic Resonance, Clinica Girona, Girona, Spain.
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Comert RB, Aydingoz U, Atay OA, Gedikoglu G, Doral MN. Vascular malformation in the infrapatellar (Hoffa's) fat pad. Knee 2004; 11:137-40. [PMID: 15066627 DOI: 10.1016/s0968-0160(03)00097-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2003] [Revised: 03/25/2003] [Accepted: 06/03/2003] [Indexed: 02/02/2023]
Abstract
A 16-year-old girl presented with pain and swelling of her right knee for 2 years. Magnetic resonance imaging disclosed a mass in the infrapatellar fat pad. Arthroscopic removal of the lesion led to a histopathologic diagnosis of vascular malformation, which has not been reported exclusively in this location.
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Affiliation(s)
- Ruhi Baris Comert
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey.
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30
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Jawa A, Hanna BG, Hubbard A, Russo P, Dormans JP. Enlarging thigh mass in a 13-month-old boy. Clin Orthop Relat Res 2003:329-35. [PMID: 12966308 DOI: 10.1097/01.blo.0000081208.51121.d4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Andrew Jawa
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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31
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van Rijswijk CSP, van der Linden E, van der Woude HJ, van Baalen JM, Bloem JL. Value of dynamic contrast-enhanced MR imaging in diagnosing and classifying peripheral vascular malformations. AJR Am J Roentgenol 2002; 178:1181-7. [PMID: 11959728 DOI: 10.2214/ajr.178.5.1781181] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Our purpose was to evaluate prospectively whether MR imaging, including dynamic contrast-enhanced MR imaging, could be used to categorize peripheral vascular malformations and especially to identify venous malformations that do not need angiography for treatment. SUBJECTS AND METHODS In this blinded prospective study, two observers independently correlated MR imaging findings of 27 patients having peripheral vascular malformations with those of diagnostic angiography and additional venography. MR diagnosis of the category, based on a combination of conventional and dynamic contrast-enhanced MR parameters, was compared with the angiographic diagnosis using gamma statistics. Sensitivity and specificity of conventional MR imaging and dynamic contrast-enhanced MR imaging in differentiating venous from nonvenous malformations were determined. RESULTS Excellent agreement between the two observers in determining MR categories (gamma = 0.99) existed. Agreement between MR categories and angiographic categories was high for both observers (gamma = 0.97 and 0.92). Sensitivity of conventional MR imaging in differentiating venous and nonvenous malformations was 100%, whereas specificity was 24-33%. Specificity increased to 95% by adding dynamic contrast-enhanced MR imaging, but sensitivity decreased to 83%. CONCLUSION Conventional and dynamic contrast-enhanced MR parameters can be used in combination to categorize vascular malformations. Dynamic contrast-enhanced MR imaging allows diagnosis of venous malformations with high specificity.
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Affiliation(s)
- Catherina S P van Rijswijk
- Department of Radiology, Leiden University Medical Center, Bldg. 1 C3-Q, 2300 RC Leiden, The Netherlands
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