Angiolithiasis in the parotid gland

Phleboliths from venous malformations of the head and neck

Objectives/Hypothesis

Phleboliths in venous malformations (VM) of the head and neck are often observed and may cause significant symptoms. Only a few articles refer to the morphology and composition of the phleboliths in VM. The objective of this study was to analyse and to demonstrate their composition and morphology.

Methods

Patients with VM presenting to a vascular anomalies centre during a three-year period were identified. The incidence of phleboliths was analysed followed by morphological and structural analysis with cone beam tomography and X-ray diffraction.

Results

Phleboliths were identified in 28/98 patients with VM of the head and neck. Seven patients underwent conventional surgery to reduce the volume of the VM or to remove the phleboliths, which were localized in the cheek (3 cases), submandibular region (2 cases), infrahyoidal neck or upper eyelid (1 case each). The structural analysis showed that more advanced lamination and an increasing radiopacity of the cortex was observed in larger phleboliths. X-ray powder diffraction analysis revealed that the main constituent in the pulverized phleboliths was carbonate-fluorohydroxylapatite.

Conclusion

This study shows in a vivid way that phleboliths from VM of the head and neck area show a laminar structure and consist of apatite, without any indication of differences in their chemical composition. Treatment of localized intravascular coagulopathy in VM might be able to prevent the formation and the progression of phleboliths. Hypothetically, another option might be lithotripsy.

Accuracy of High-resolution Sonography Compared with Magnetic Resonance Imaging in the Diagnosis of Head and Neck Venous Vascular Malformations

AIMS

To evaluate whether modern ultrasound examination helps to establish the diagnosis of head and neck venous vascular malformations (VVMs) and whether it can delineate their full extent.

MATERIALS AND METHODS

Sonographic appearances of 30 head and neck VVMs were assessed for: location, extent, internal architecture, presence of flow and phleboliths. These results were compared with the magnetic resonance imaging (MRI) of the same patients.

RESULTS

The lesions showed well-defined margins (22 of 30, 73%), heterogeneous (30 of 30, 100%) and hypoechoic echo pattern (27 of 30, 90%), with sinusoidal spaces (28 of 30, 93%) and phleboliths (24 of 30, 80%) on grey-scale imaging, and flow signal on Doppler (28 of 30, 93%). For delineating the extent, ultrasound was comparable with MRI in 53% (16 of 30) and inferior to MRI in 47% (14 of 30). Ultrasound did not detect deeper extent, intra-osseous involvement and other clinically occult VVMs.

CONCLUSION

Ultrasound with high-resolution transducers can confidently suggest the diagnosis of head and neck VVMs in up to 90% of cases, and delineate the full extent of some superficial lesions. The major disadvantage is its inability to evaluate intra-osseous involvement and the entire extent of large, deep-seated lesions.

Angiolithiasis and sialolithiasis in the head and neck

Of the two principal forms of macrolithiasis and microlithiasis in the head and neck, that occurring in salivary glands (sialoliths) is much more prevalent than intravascular lithiasis (angioliths). Sialoliths are also more often symptomatic, particularly when formed in the preponderant gland of involvement, the submandibular gland. Angiolithiasis is always coincidental with vascular stasis: in hemangiomas or varices. Both forms of lithiasis share several radiographic features and have a similar basis of formation. For sialoliths, secretory stasis forms a nidus for mineralization. Thrombus formation in vessels is the formative “nucleus” for an angiolith.

Phleboliths. A report of three unusual cases

Phleboliths are well established pathological entities that are often associated with vascular lesions. Three cases are reported in which no vascular malformation was detected.

Buccal hemangioma with phleboliths. Report of two cases

Two cases of buccal hemangioma with phleboliths were reported. Angiography, angioxerography, and computerized tomography were carried out before the procedures were planned. One patient was treated by means of surgical excision of the tumor after ligation of the left external carotid artery. The second patient was treated by means of surgical excision alone. Histologic examinations suggested that the thrombi in the blood vessels of hemangiomas might become the core of the phleboliths. Analysis of the phleboliths by means of x-ray diffraction and infrared spectrometry confirmed calcium phosphate and calcium carbonate as the main components of the phleboliths.

Phlebolithiasis associated with intramuscular hemangioma. X-ray diffractometric, X-ray microanalytical and scanning electron microscopic investigations

Phlebolithiasis associated with intramuscular hemangioma is relatively rare. Combined crystallographic, microanalytical and morphological studies have not been done before. We investigated a case of phlebolithiasis by scanning electron microscopy, X-ray microdiffractometry and energy-dispersive X-ray microanalysis. The calculus revealed a lamellar structure with irregular distribution of radipaque and radiolucent portions. The radiopaque portions contained apatite which could be demonstrated in prismlike as well as globular granular structures. In contrast to other authors, brushite was not detected by us. The radiolucent protions adjacent to the stone surface contained sulfur and showed undefined diffraction peaks supposing the presence of organic crystals. The possible milieu factors govering calculus formation are discussed.