Clinical diagnosis of caliber-persistent labial artery of the lower lip

Caliber-Persistent Labial Artery: A Report of a Rarely Recognized Lip Swelling

Calibre-persistent labial artery (CPLA) is a commonly underdiagnosed vascular lesion of the lip. CPLA is an arterial branch that penetrates the submucosal tissue without loss of calibre. Clinical diagnosis is significant as misdiagnosis can lead to profuse haemorrhage following an excisional biopsy or surgical excision. Colour Doppler ultrasonography is a safe and non-invasive diagnostic tool to confirm the diagnosis. Here, we report a case of a 24-year-old man who complained of an asymptomatic pulsating non-progressive nodule on the left side of upper lip initially diagnosed as peripheral angiomatous lesion. Diagnosis was confirmed by high-resolution Colour Doppler Ultrasonography. The purpose of this case report is to highlight the clinical importance and diagnosis of a rarely reported soft tissue swelling of the lip to the attention of clinicians.

A new approach to the management of caliber-persistent artery: A case report and analysis of previously reported cases

A caliber-persistent labial artery (CPLA) is an incipient arterial branch that penetrates near the submucosal tissue of the lip without dividing or reducing in diameter and often appears as a palpable lesion on the lip. It occurs at an incidence of approximately 3%. This study investigated the causes of swelling of the lips, focusing on CPLA, and reviewed the literature for past cases in order to inform the treatment of a 32-year-old man presenting with an asymptomatic, solitary, elevated lesion on the vermilion of the upper lip of seven months duration. Biopsy resulted in abundant bleeding. Histopathology showed fragments of connective tissue composed of spindle-shaped cells, fibroblasts, collagen fibers and sections of small blood vessels with lymphocytic infiltration of chronic inflammatory cells around the small vessels. A thick-walled section reminiscent of a major artery was apparent. In view of the size of the lesion and concern over the functional and esthetic impairment that might result from surgery, the patient was treated with triamcinolone (40 mg/ml) injected at low pressure into the lesion, which caused the formation of deposits of colloidal particles within the lesion. The procedure was repeated twice at 2-week intervals. Subsequently, the lesion was found to have completely regressed. The favorable therapeutic results achieved, and the findings of the present review, support the intralesional injection of triamcinolone as a first-line conservative treatment in CPLA rather than a surgical approach that can result in inordinate hemorrhaging.

Caliber-Persistent Artery

Caliber-persistent artery (CPLA) of the lip is a common vascular anomaly in which a main arterial branch extends to the surface of the mucous tissue with no reduction in its diameter. It usually manifests as pulsatile papule, is easily misdiagnosed, and is observed more frequently among older people, suggesting that its development may involve a degenerative process associated with aging; CPLA is also characterized by the loss of tone of the adjacent supporting connective tissue. Although the diagnosis is clinical, high-resolution Doppler ultrasound is a useful noninvasive tool for evaluating the lesion. This report describes the case of a 58-year-old male patient who complained of a lesion of the lower lip with bleeding and recurrent ulceration. The patient was successfully treated in our hospital after a diagnosis of CPLA and is currently undergoing a clinical outpatient follow-up with no complaints.

Calibre Persistent Labial Artery: Clinical Features and Immunohistochemistry Diagnosis

Calibre persistent labial artery (CPLA) usually presents as an asymptomatic papule on the lower lip and can be easily misdiagnosed as a mucocele, haemangioma, venous lake, varix or fibroma. When it is ulcerated, squamous cell carcinoma is the most usual differential diagnosis. Here, we report a case of a 25-year-old woman with no previous relevant medical history who presented with a complaint of an asymptomatic, non-ulcerated, progressively growing nodule (over the last 5 months) on the upper lip. In this case, the diagnosis was made clinically and confirmed by immunohistochemical analysis. We conclude that clinicians should be aware of CPLA and it should be included in the differential diagnosis of labial mucosal papules. Sometimes, the immunohistochemical analysis is necessary to make a correct diagnosis.

Calibre-persistent labial artery: often misdiagnosed as a mucocoele

The authors present five cases of calibre-persistent labial artery (CPLA) all of which were diagnosed clinically as a labial mucocoele. The purpose of this article is to bring this rarely reported lesion to the attention of clinicians.

Intra-oral calibre persistent artery

Calibre persistent arteries (CPA) penetrate into submucosal tissue without division or reduction in calibre. Intraorally, these abnormalities have been predominantly reported in the lip. Here we report a case of CPA in the buccal vestibule. Misdiagnosis of this entity may result in profuse bleeding during surgical intervention.

Calibre persistent labial artery: clinical features and noninvasive radiological diagnosis

Calibre persistent labial artery (CPLA) is defined as a primary arterial branch that penetrates into the submucosal tissue without division or decrease in diameter. It usually presents as an asymptomatic papule on the lower lip and can be easily misdiagnosed as a varix, haemangioma, venous lake, mucocele or fibroma. When it is ulcerated, squamous cell carcinoma is the most usual differential diagnosis. The most frequently used method to confirm the diagnosis of CPLA has been excisional biopsy, which carries the risk of profuse bleeding. Angiography, another invasive method, has also been used. Here, we report a case of a 20-year-old woman with a 5-year history of multiple CPLA lesions involving both upper and lower lips. In this case, the diagnosis was made clinically and confirmed by Doppler ultrasonography, which is a noninvasive and simple diagnostic tool.

Ultrasonography: a noninvasive tool to diagnose a caliber-persistent labial artery, an enlarged artery of the lip

OBJECTIVE

Currently, practitioners use clinical and histopathologic examination to diagnose a caliber-persistent labial artery (CPLA). We illustrate the use of ultrasonography as a noninvasive diagnostic tool to visualize this enlarged artery of the lip.

METHODS

We examined the lips of 3 patients with a suspected CPLA. We localized and determined the extension of the intralabial artery with ultrasonography, including pulsed and color Doppler analysis. We compared the sonograms to the clinical and histopathologic findings.

RESULTS

Sonograms showed clear enlargement of the labial artery in the 3 cases. The course of the constant-diameter artery was either vertical or oblique from the depth of the lip to the surface of the mucosa. This vascular abnormality was confirmed by histopathologic examination.

CONCLUSIONS

Ultrasonography and color Doppler imaging may be useful noninvasive tools for the diagnosis and preoperative evaluation, as well as the follow-up, of labial lesions related to a CPLA, thus eliminating the need for diagnostic surgery in typical pulsatile nodules. Ultrasonography may help distinguish a CPLA from other vascular lesions of the lip such as an aneurysm. Atypical cases or chronic ulcerations mimicking a cancer should undergo biopsy so that a malignant process is not missed.

Caliber-persistent labial artery. A common vascular anomaly

Sixteen cases of caliber-persistent labial artery of the lips have been reported to date in the English literature. Six of these were clinically misdiagnosed as squamous cell carcinoma and treated with wedge resection. To date, we have seen 187 cases clinically and an additional 23 cases through our surgical oral pathology services. Careful clinical observation usually reveals a soft linear or papular bluish elevation above the labial mucosal surface. The unique feature is pulsation--not simply pulsation toward and away from the observer, which can be caused by an underlying artery, but lateral pulsation, which only an artery can exhibit. All but 2 of our 187 clinical cases were asymptomatic. To the best of our knowledge, this is the first report of caliber-persistent labial artery of the upper lip. The upper:lower lip ratio for the clinical cases was almost 2:1. Three times as many lower lip as upper lip lesions were biopsied. Males and females were almost equally affected (clinical cases, 76:86; histopathologic cases, 9:13). Although a vascular term (artery, hemangioma, phlebolith, varix, vascular malformation) was used on the biopsy form in one half of the clinical differential diagnoses, none of the clinical histories mentioned pulsation. In contrast to the cases of Miko et al. in 1980 and 1983, none of our cases manifested itself as an ulcer, nor was carcinoma ever mentioned in the clinical differential diagnosis. The purpose of this article is to familiarize clinicians and pathologists with the clinical and histopathologic features of this seldom reported but common vascular anomaly. Clinicians should carefully look for lateral pulsation in lip mucosal papules so as to avoid unnecessary surgery and intraoperative arterial bleeding. Pathologists should recognize that a relatively large-caliber superficial artery in a lip biopsy may not be an incidental finding but rather the clinical lesion that was biopsied.