1
|
Bardo DME, Gill AE, Iyer RS, Chan SS, Cooper ML, Dasgupta RA, Guimaraes CV, Hammer MR, Krowchuk DP, Levin TL, Liang MG, Meyers ML, Samet JD, Sammer MBK, Schooler GR, Squires JH, Sura AS, Trout AT, Pruthi S. ACR Appropriateness Criteria® Soft Tissue Vascular Anomalies: Vascular Malformations and Infantile Vascular Tumors (Non-CNS)-Child. J Am Coll Radiol 2024; 21:S310-S325. [PMID: 38823953 DOI: 10.1016/j.jacr.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Soft tissue vascular anomalies may be composed of arterial, venous, and/or lymphatic elements, and diagnosed prenatally or later in childhood or adulthood. They are divided into categories of vascular malformations and vascular tumors. Vascular malformations are further divided into low-flow and fast-flow lesions. A low-flow lesion is most common, with a prevalence of 70%. Vascular tumors may behave in a benign, locally aggressive, borderline, or malignant manner. Infantile hemangioma is a vascular tumor that presents in the neonatal period and then regresses. The presence or multiple skin lesions in an infant can signal underlying visceral vascular anomalies, and complex anomalies may be associated with overgrowth syndromes. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Collapse
Affiliation(s)
- Dianna M E Bardo
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
| | - Anne E Gill
- Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia
| | - Ramesh S Iyer
- Panel Chair, Seattle Children's Hospital, Seattle, Washington
| | - Sherwin S Chan
- Panel Vice Chair, Children's Mercy Hospital, Kansas City, Missouri
| | | | - Roshni A Dasgupta
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; American Pediatric Surgical Association
| | | | | | - Daniel P Krowchuk
- Wake Forest University School of Medicine, Winston Salem, North Carolina; American Academy of Pediatrics
| | - Terry L Levin
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Marilyn G Liang
- Boston Children's Hospital, Boston, Massachusetts; Society for Pediatric Dermatology
| | - Mariana L Meyers
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Jonathan D Samet
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Gary R Schooler
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Judy H Squires
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amit S Sura
- Children's Hospital Los Angeles, Los Angeles, California
| | - Andrew T Trout
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Commission on Nuclear Medicine and Molecular Imaging
| | - Sumit Pruthi
- Specialty Chair, Vanderbilt Children's Hospital, Nashville, Tennessee
| |
Collapse
|
2
|
Matsuzawa Adachi M, Sugawara H, Ishii A, Chiba E, Hamamoto K, Demitsu T, Yamada S. Malignancy-related Hypercalcemia Caused by Metameric Cutaneous Metastasis of Parathyroid Hormone-related Protein-producing Bladder Carcinoma with Squamous Cell Differentiation: An Autopsy Case of Cobb Syndrome. Intern Med 2023; 62:3075-3084. [PMID: 36858515 PMCID: PMC10641195 DOI: 10.2169/internalmedicine.0893-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/23/2023] [Indexed: 03/03/2023] Open
Abstract
A 74-year-old woman was admitted with hypercalcemia and prolonged disturbance of consciousness. The left buttock to the anterior aspect of the left thigh was swollen and erythematous, with a collection of 1.0-cm large, firm, elastic nodules distributed in a zosteriform pattern in the L1-L4 region. Based on autopsy findings, a very rare case of Cobb syndrome was diagnosed due to a spinal vascular malformation at the Th12-L4 level and L5 vertebral hemangioma. Cobb syndrome-associated cutaneous metastasis extending along the same metamere was complicated by immunohistochemically proven parathyroid hormone-related protein-producing advanced bladder carcinoma in this case.
Collapse
Affiliation(s)
- Michiko Matsuzawa Adachi
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Japan
| | - Hitoshi Sugawara
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Japan
| | - Akira Ishii
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Japan
| | - Emiko Chiba
- Department of Radiology, Saitama Medical Center, Jichi Medical University, Japan
| | - Kohei Hamamoto
- Department of Radiology, Saitama Medical Center, Jichi Medical University, Japan
| | - Toshio Demitsu
- Division of Dermatology, Department of Comprehensive Medicine 2, Saitama Medical Center, Jichi Medical University, Japan
| | - Shigeki Yamada
- Department of Pathology, Saitama Medical Center, Jichi Medical University, Japan
| |
Collapse
|
3
|
Ionita IG, Zainea V, Voiosu C, Stefanescu CD, Panea CA, Dumitru AV, Alius RO, Hainarosie R. Management of Capillary Hemangioma of the Sphenoid Sinus. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050858. [PMID: 37241090 DOI: 10.3390/medicina59050858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023]
Abstract
Background and objectives: Capillary hemangiomas are rare, benign vascular tumors that mainly affect the skin and soft tissue, with scarce appearance within the nasal cavities and paranasal sinuses. Materials and methods: We present a case report of capillary hemangioma of the sphenoid sinus and a review of the literature in the last ten years. Results: Clinical and endoscopic examination of the nose, radiologic assessment and particular histologic features contribute to the correct diagnosis of capillary hemangioma of the nose and paranasal sinuses. Conclusions: Transnasal endoscopic resection of capillary hemangioma located in the nose and paranasal sinuses is a valuable treatment method with good outcomes.
Collapse
Affiliation(s)
- Irina-Gabriela Ionita
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 8th Eroii Sanitari Boulevard, 050474 Bucharest, Romania
- "Prof. Dr. D. Hociota" Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania
| | - Viorel Zainea
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 8th Eroii Sanitari Boulevard, 050474 Bucharest, Romania
- "Prof. Dr. D. Hociota" Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania
| | - Catalina Voiosu
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 8th Eroii Sanitari Boulevard, 050474 Bucharest, Romania
- "Prof. Dr. D. Hociota" Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania
| | - Cristian Dragos Stefanescu
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 8th Eroii Sanitari Boulevard, 050474 Bucharest, Romania
- "Prof. Dr. D. Hociota" Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania
| | - Cristina Aura Panea
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 8th Eroii Sanitari Boulevard, 050474 Bucharest, Romania
- Neurology Department, Elias Emergency University Hospital, 17th Marasti Boulevard, 011461 Bucharest, Romania
| | - Adrian Vasile Dumitru
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 8th Eroii Sanitari Boulevard, 050474 Bucharest, Romania
- Pathology Department, Emergency University Hospital, 169th Independence Street, 050098 Bucharest, Romania
| | - Ruxandra Oana Alius
- "Prof. Dr. D. Hociota" Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania
| | - Razvan Hainarosie
- ENT Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 8th Eroii Sanitari Boulevard, 050474 Bucharest, Romania
- "Prof. Dr. D. Hociota" Institute of Phonoaudiology and Functional ENT Surgery, 21st Mihail Cioranu Street, 061344 Bucharest, Romania
| |
Collapse
|
4
|
Cekuolis A, Schreiber-Dietrich D, Augustinienė R, Taut H, Squires J, Chaves EL, Dong Y, Dietrich CF. Incidental Findings in Pediatric Patients: How to Manage Liver Incidentaloma in Pediatric Patients. Cancers (Basel) 2023; 15:cancers15082360. [PMID: 37190288 DOI: 10.3390/cancers15082360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings (IFs) with a series of publications entitled "Incidental imaging findings-the role of ultrasound". IFs in the liver of newborns and children are rare and much less commonly encountered than in adults; as a result, they are relatively much more frequently malignant and life-threatening, even when they are of benign histology. Conventional B-mode ultrasound is the well-established first line imaging modality for the assessment of liver pathology in pediatric patients. US technological advances, resulting in image quality improvement, contrast-enhanced ultrasound (CEUS), liver elastography and quantification tools for steatosis have expanded the use of ultrasound technology in daily practice. The following overview is intended to illustrate incidentally detected liver pathology covering all pediatric ages. It aims to aid the examiner in establishing the final diagnosis. Management of incidentally detected focal liver lesions (FLL) needs to take into account the diagnostic accuracy of each imaging modality, the patient's safety issues (including ionizing radiation and nephrotoxic contrast agents), the delay in diagnosis, the psychological burden on the patient and the cost for the healthcare system. Moreover, this paper should help the pediatric clinician and ultrasound practitioner to decide which pathologies need no further investigation, which ones require interval imaging and which cases require further and immediate diagnostic procedures.
Collapse
Affiliation(s)
- Andrius Cekuolis
- Ultrasound Section, Department of Pediatric Radiology, Radiology and Nuclear Medicine Centre, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | | | - Rasa Augustinienė
- Ultrasound Section, Department of Pediatric Radiology, Radiology and Nuclear Medicine Centre, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | - Heike Taut
- Children's Hospital, Universitätsklinikum Dresden, Technische Universität Dresden, 01062 Dresden, Germany
| | - Judy Squires
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Edda L Chaves
- Radiology Department, Hospital Regional Nicolas Solano, La Chorrera 1007, Panama
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, 3013 Bern, Switzerland
| |
Collapse
|
5
|
Das A, Goyal A, Sangwan A, Bhalla AS, Kumar A, Kandasamy D, Dawar R. Vascular anomalies: nomenclature, classification, and imaging algorithms. Acta Radiol 2023; 64:837-849. [PMID: 35414244 DOI: 10.1177/02841851221082241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is a lot of ambiguity in the usage of correct terminology in the description of vascular malformations and tumors. Hemangioma and arteriovenous malformation (AVM) are the most commonly used terms and are the mostly incorrectly used as well! The aim of this review article was to lay out the correct nomenclature and describe the correct usage for the physicians and radiologists involved in diagnosing and managing these lesions. We describe the various classification systems which have been devised to define the multiple entities included under vascular anomalies. The latest classification system that should be adhered to is per the International Society for the Study of Vascular Anomalies, approved at the 20th ISSVA Workshop held in Melbourne in April 2014, last revised in May 2018. The main features of the latest revision have been highlighted. This classification, however, does not list the diagnostic clinico-radiological features for each entity. In addition, guidelines regarding the appropriate use of available imaging modalities are lacking in the literature. We, hereby, aim to address these pertinent issues in this review article.
Collapse
Affiliation(s)
- Abanti Das
- Department of Radiodiagnosis, and Interventional Radiology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiodiagnosis, and Interventional Radiology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Sangwan
- Department of Radiodiagnosis, and Interventional Radiology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis, and Interventional Radiology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Atin Kumar
- Department of Radiodiagnosis, and Interventional Radiology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Devasenathipathy Kandasamy
- Department of Radiodiagnosis, and Interventional Radiology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Dawar
- Department of Plastic, Reconstructive and Burns Surgery, Department of Radiodiagnosis and Interventional Radiology, 28730All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
6
|
YILMAZ TF, TOPRAK H, ATASOY B, SÖNMEZ FC, ARALAŞMAK A, GÜRKAN V. Radiological Appearences of Benign Soft-tissue Tumors of the Hand and Wrist with Special Emphasis on MRI. BEZMIALEM SCIENCE 2022. [DOI: 10.14235/bas.galenos.2021.6398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
7
|
Neonatal vascular anomalies manifesting as soft-tissue masses. Pediatr Radiol 2022; 52:786-801. [PMID: 34374837 DOI: 10.1007/s00247-021-05149-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/25/2021] [Accepted: 06/28/2021] [Indexed: 01/19/2023]
Abstract
The broad and heterogeneous spectrum of vascular anomalies ranges from an innocuous localized cutaneous discoloration to complex, extensive and life-threatening diagnoses. While many of these lesions are present at birth, smaller and deeper lesions might be clinically occult for months or years. Certain vascular anomalies commonly manifest in the prenatal or neonatal period and often have suggestive clinical and imaging features that can aid the radiologist in making a correct diagnosis. The characteristics of such lesions presenting very early in life, particularly those manifesting as soft-tissue masses, are the focus of this review.
Collapse
|
8
|
Tawfik HA, Dutton JJ. Orbital Vascular Anomalies: A Nomenclatorial, Etiological, and Nosologic Conundrum. Ophthalmic Plast Reconstr Surg 2022; 38:108-121. [PMID: 34238823 DOI: 10.1097/iop.0000000000002029] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Vascular anomalies are a heterogeneous group of disorders that frequently present in the periorbital region. They encompass 2 broad entities: vascular tumors, which possess a proliferative endothelium, and vascular malformations, which are basically localized defects of vascular morphogenesis. The primary goal of this review was to address inaccurate or controversial terminology in the oculoplastic literature concerning orbital and periorbital vascular anomalies and to categorize these lesions in an abridged and simplified hierarchical list that adheres as much as possible to the most recent (2018) iteration for the classification of vascular lesions proposed by the International Society for the Study of Vascular Anomalies (ISSVA). The secondary goal of this review was to review and update information regarding the genetic underpinnings of vascular anomalies and the downstream signaling pathways that are subsequently affected as a result of these genetic errors. METHODS A literature review was conducted in PubMed, MEDLINE, PubMed Central, National Center for Biotechnology Information Bookshelf, and Embase for several related keywords including "vascular anomalies, vascular malformations, vascular tumors, and cavernous venous malformation," both with and without adding the keywords "eyelid," "orbital," and "periorbital." In addition, a detailed search was conducted for controversial or obsolete keywords like "cavernous hemangioma," "lymphangioma," and "varices," again in their systemic and orbital/periorbital context. RESULTS Crucial issues in the 2018 ISSVA classification regarding the proper categorization of orbital vascular anomalies, particularly venous lesions, were critically evaluated and revised, and a regional, simplified, and abridged modification of the ISSVA 2018 classification was proposed. CONCLUSIONS Interdisciplinary and intradisciplinary dialogue concerning orbital vascular anomalies is seriously compromised due to the lack of a unanimous agreement on terminology and the absence of a unified classification concept system. The authors recommend that oculoplastic surgeons adopt ISSVA terminology whenever technically possible and scientifically sound. However, they also propose modifying the ISSVA 2018 classification specifically to adapt to the peculiarities of vascular anomalies in the periorbital region. At present, the simplified classification proposed here is a preliminary first step towards managing patients with orbital vascular anomalies with greater diagnostic and therapeutic precision, until such time in the future when the entire genetic makeup of orbital vascular anomalies is more completely elucidated. Optimistically, this could pave the way for a more robust classification and the ultimate therapeutic cure.
Collapse
Affiliation(s)
- Hatem A Tawfik
- Department of Ophthalmology, Ain Shams University, Cairo, Egypt
| | - Jonathan J Dutton
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| |
Collapse
|
9
|
Locker SH, Maxwell EA, Vilaplana Grosso F, Bertran J, Shiomitsu K. Novel treatment of recurrent abdominal lymphatic malformations in a dog. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Seth H Locker
- Department of Small Animal Clinical Sciences College of Veterinary Medicine University of Florida Gainesville Florida USA
| | - Elizabeth A Maxwell
- Department of Small Animal Clinical Sciences College of Veterinary Medicine University of Florida Gainesville Florida USA
| | - Federico Vilaplana Grosso
- Department of Small Animal Clinical Sciences College of Veterinary Medicine University of Florida Gainesville Florida USA
| | - Judith Bertran
- Department of Small Animal Clinical Sciences College of Veterinary Medicine University of Florida Gainesville Florida USA
| | - Keijiro Shiomitsu
- Department of Small Animal Clinical Sciences College of Veterinary Medicine University of Florida Gainesville Florida USA
| |
Collapse
|
10
|
Larson AS, Brinjikji W, Anderson KR, Tollefson M, Michelle Silvera V, Guerin JB. Imaging of benign cervicofacial vascular anomalies and associated syndromes. Interv Neuroradiol 2021; 28:364-374. [PMID: 34397285 DOI: 10.1177/15910199211034989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Cervicofacial vascular anomalies can result in morbidity, pain, and cosmetic concerns in affected individuals. Each anomaly has its own unique natural history, treatment, and associations with underlying genetic syndromes. For optimal patient care, it is important for the neuroradiologist to accurately recognize and characterize these entities to ensure appropriate treatment and management. In this review, we discuss the general characteristics, classifications, and imaging features associated with the most common vascular anomalies such as hemangiomas, arteriovenous malformations and fistulas, capillary malformations, venous malformations, and lymphatic malformations in the context of associated syndromes. Additionally, we discuss novel imaging techniques that aid in identifying these vascular anomalies.
Collapse
Affiliation(s)
| | - Waleed Brinjikji
- Department of Radiology, 6915Mayo Clinic, USA.,Department of Neurosurgery, 6915Mayo Clinic, USA
| | | | - Megha Tollefson
- Department of Dermatology, 6915Mayo Clinic, USA.,Department of Pediatric & Adolescent Medicine, 6915Mayo Clinic, USA
| | | | | |
Collapse
|
11
|
Jeong GS, Bae SH, Do YS, Lee HN, Lee SJ. Transvaginal Direct Puncture and Ethanol Sclerotherapy for Cervicovaginal Venous Malformations: A Case Report and Literature Review. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:688-692. [PMID: 36238788 PMCID: PMC9432453 DOI: 10.3348/jksr.2020.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/05/2020] [Accepted: 07/12/2020] [Indexed: 11/17/2022]
Abstract
Cervicovaginal venous malformations are extremely rare. Sclerotherapy is proven to be effective for superficial venous malformations but not for venous malformations in the lower genital tract of women. A 52-year-old female presented with intermittent vaginal bleeding. The amount of vaginal bleeding gradually increased over 3 months. Contrast-enhanced pelvis CT showed several phleboliths and dilated vessels, but pelvic angiography showed no early draining veins, nidus, or feeding artery. We performed transvaginal direct puncture and ethanol sclerotherapy rather than surgical treatment because she wanted to preserve the uterus. After four sessions of sclerotherapy, she had significantly decreased vaginal bleeding without complications. Here, we report the first case of cervicovaginal venous malformations successfully treated with transvaginal direct puncture and ethanol sclerotherapy.
Collapse
Affiliation(s)
- Gu Seong Jeong
- Department of Radiology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Suk Hyun Bae
- Department of Radiology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Young Soo Do
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyoung Nam Lee
- Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Sang Joon Lee
- Department of Radiology, Kangwon National University Hospital, College of Medicine, Kangwon National University, Chuncheon, Korea
| |
Collapse
|
12
|
Ultrasound Evaluation of Pediatric Slow-Flow Vascular Malformations: Practical Diagnostic Reporting to Guide Interventional Management. AJR Am J Roentgenol 2020; 216:494-506. [PMID: 33356433 DOI: 10.2214/ajr.20.23338] [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: 01/21/2023]
Abstract
OBJECTIVE. This article reviews the ultrasound characteristics of pediatric slow-flow vascular malformations and underscores findings that significantly impact diagnosis and treatment. Key imaging features are discussed including lesion size, malformation location, morphology, and mimics. CONCLUSION. Ultrasound findings affect the management of slow-flow vascular malformations and should be emphasized in lesion diagnosis. Superficial, focal lesions with well-defined margins are ideal for ultrasound evaluation.
Collapse
|
13
|
Aulino JM, Kirsch CFE, Burns J, Busse PM, Chakraborty S, Choudhri AF, Conley DB, Jones CU, Lee RK, Luttrull MD, Moritani T, Policeni B, Ryan ME, Shah LM, Sharma A, Shih RY, Subramaniam RM, Symko SC, Bykowski J. ACR Appropriateness Criteria ® Neck Mass-Adenopathy. J Am Coll Radiol 2020; 16:S150-S160. [PMID: 31054741 DOI: 10.1016/j.jacr.2019.02.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 11/26/2022]
Abstract
A palpable neck mass may be the result of neoplastic, congenital, or inflammatory disease. Older age suggests neoplasia, and a congenital etiology is more prevalent in the pediatric population. The imaging approach is based on the patient age, mass location, and clinical pulsatility. Underlying human papillomavirus-related malignancy should be considered in all age groups. Although the imaging appearance of some processes in the head and neck overlap, choosing the appropriate imaging examination may allow a specific diagnosis, or a limited differential diagnosis. Tissue sampling is indicated to confirm suspected malignancy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
| | | | - Claudia F E Kirsch
- Panel Chair, Northwell Health, Zucker Hofstra School of Medicine at Northwell, Manhasset, New York
| | | | - Paul M Busse
- Massachusetts General Hospital, Boston, Massachusetts
| | - Santanu Chakraborty
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada, Canadian Association of Radiologists
| | - Asim F Choudhri
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - David B Conley
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, American Academy of Otolaryngology-Head and Neck Surgery
| | | | - Ryan K Lee
- Einstein Healthcare Network, Philadelphia, Pennsylvania
| | | | | | - Bruno Policeni
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Maura E Ryan
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Aseem Sharma
- Mallinckrodt Institute of Radiology, Saint Louis, Missouri
| | - Robert Y Shih
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | | | - Julie Bykowski
- Specialty Chair, UC San Diego Health Center, San Diego, California
| |
Collapse
|
14
|
Ueyama A, Wada Y, Yamamoto M, Mihara S, Iiboshi Y. Neonatal umbilical arteriovenous fistula in a previously intact umbilicus. Pediatr Int 2020; 62:989-990. [PMID: 32618412 DOI: 10.1111/ped.14222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/20/2020] [Accepted: 02/25/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Atsuko Ueyama
- Department of Pediatrics, Rinku General Medical Center, Izumisano city, Osaka, Japan
| | - Yoshiro Wada
- Department of Pediatrics, Rinku General Medical Center, Izumisano city, Osaka, Japan
| | - Masahiro Yamamoto
- Department of Pediatrics, Rinku General Medical Center, Izumisano city, Osaka, Japan
| | - Seiko Mihara
- Department of Pediatrics, Rinku General Medical Center, Izumisano city, Osaka, Japan
| | - Yasuhiko Iiboshi
- Department of Pediatrics, Rinku General Medical Center, Izumisano city, Osaka, Japan
| |
Collapse
|
15
|
Zaltsberg GS, Spring S, Malic C, Koujok K, Davila J, Hurteau J, Shenouda N. Soft Tissue Lesions With High Vascular Density on Sonography in Pediatric Patients: Beyond Hemangiomas [Formula: see text]. Can Assoc Radiol J 2020; 71:505-513. [PMID: 32054306 DOI: 10.1177/0846537119899539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Infantile hemangiomas are the most frequent vascular soft tissue lumps in the pediatric population. The clinical presentation and evolution of these lesions is characteristic, while the sonographic appearance is classic but not specific. This pictorial essay illustrates the different vascular soft tissue lumps on ultrasound that may mimic infantile hemangiomas. Awareness of these mimics is crucial to avoid misdiagnosis. Clinical and sonographic discriminators for each lesion are presented.
Collapse
Affiliation(s)
| | - Shanna Spring
- Department of Dermatology, CHEO, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Claudia Malic
- Department of Plastic Surgery, CHEO, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Khaldoun Koujok
- Department of Medical Imaging, CHEO, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Jorge Davila
- Department of Medical Imaging, CHEO, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Julie Hurteau
- Department of Medical Imaging, CHEO, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Nazih Shenouda
- Department of Medical Imaging, CHEO, 6363University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
16
|
Contrast-enhanced ultrasound of liver lesions in children. Pediatr Radiol 2019; 49:1422-1432. [PMID: 31620843 DOI: 10.1007/s00247-019-04361-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/14/2019] [Accepted: 02/14/2019] [Indexed: 12/13/2022]
Abstract
Initial pediatric imaging of the liver heavily relies on ultrasonography (US) because it is free of ionizing radiation, easily portable and readily available. Although conventional US (gray-scale and color Doppler) is often an excellent screening tool, its relative low specificity compared to CT/MRI limits liver lesion characterization. The United States Food and Drug Administration's recent approval of an intravenous US contrast agent for pediatric liver lesion characterization (sulfur hexafluoride lipid-type A microspheres) and its excellent safety profile have spurred increased interest in contrast-enhanced US for definitive diagnosis of pediatric liver lesions. This review focuses on the safety of contrast-enhanced US, role of contrast-enhanced US in the evaluation of focal liver lesions, basic contrast-enhanced US technique for liver imaging, and interpretation principles. The authors review common focal liver lesions, with special attention to the role of contrast-enhanced US in the pediatric oncology population.
Collapse
|
17
|
Steele L, Zbeidy S, Thomson J, Flohr C. How is the term haemangioma used in the literature? An evaluation against the revised ISSVA classification. Pediatr Dermatol 2019; 36:628-633. [PMID: 31318089 DOI: 10.1111/pde.13885] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND/OBJECTIVES The International Society for the Study of Vascular Anomalies (ISSVA) classification separates vascular anomalies into vascular malformations and vascular tumors. However, misdiagnoses and misperceptions still persist around the use of the term "hemangioma." We assessed whether the term "haemangioma" (British spelling) was used as part of ISSVA terminology in the literature. METHODS We searched PubMed for all English-language publications containing the British spelling "haemangioma" in the title or abstract from January 1, 2015 to December 31, 2016. Each paper was judged by two independent reviewers, with conflicts resolved by senior review. RESULTS By the standard of the 2014 ISSVA classification, 126/195 (64.6%) publications used incorrect terminology for vascular anomalies. This was reduced to 118/195 (60.5%) when using the 2018 ISSVA classification. The most commonly misused terms were cavernous haemangioma (27.1%), haemangioma without further specification (26.3%), and hepatic/liver haemangioma (12.7%). Age was a significant predictor of accuracy of terminology (P = 0.01), with a higher accuracy in children. Correct usage also varied by the site of the vascular anomaly, being highest for lesions of the skin (76.5%) followed by muscle (58.3%), soft tissue (23.5%), bone (21.4%), viscera (7.7%), and eye (0.0%) (P = 0.02). CONCLUSIONS The term "haemangioma" is frequently used incorrectly by the standards of the 2014 and 2018 ISSVA classifications. Correct terminology is important as the natural history and treatment options vary depending on the type of vascular anomaly.
Collapse
Affiliation(s)
- Lloyd Steele
- Department of Dermatology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Sarah Zbeidy
- Department of Dermatology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Jason Thomson
- Department of Dermatology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Carsten Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, King's College London and Guy's & St Thomas' Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
18
|
Gong X, Ying H, Zhang Z, Wang L, Li J, Ding A, Zhou L, Lin X, Xiong P. Ultrasonography and magnetic resonance imaging features of kaposiform hemangioendothelioma and tufted angioma. J Dermatol 2019; 46:835-842. [PMID: 31373042 DOI: 10.1111/1346-8138.15025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 06/26/2019] [Indexed: 12/21/2022]
Abstract
Kaposiform hemangioendothelioma (KHE) and tufted angioma (TA) primarily occurring in infants are difficult to distinguish. This study evaluated ultrasonography (US) and magnetic resonance imaging (MRI) features of KHE and TA. Pathologically proven TA (n = 21) and KHE (n = 40 [11 KHE + Kasabach-Merritt phenomenon [KMP]]) occurring between January 2015 and December 2017 were reviewed. US (n = 61) and MRI (n = 50) findings were retrospectively evaluated. On US, KHE and TA lesions were subcutaneous, while 40% of KHE exhibited an infiltrative pattern extending into adjacent muscles. Of TA lesions, 42.9% were hyperechoic and 96.15% of KHE lesions exhibited mixed echogenicity. Of TA lesions, 76.2% exhibited well-defined margins and all KHE lesions exhibited ill-defined margins. The depth and vascular density of KHE and KHE + KMP were significantly increased compared with TA. The arterial peak systolic blood flow velocity of KHE + KMP was significantly higher than that in TA and KHE. KHE and KHE + KMP were significantly harder than TA on elastography. 3-D color Doppler revealed branch-shape blood flow for KHE and KHE + KMP lesions; for TA, it revealed a dot-like and striped pattern. Considering MRI findings, KHE and KHE + KMP were more likely to exhibit diffuse heterogeneous enhancement after contrast than TA. KHE was infiltrative and more likely to be thick, hypoechoic, ill-defined, richly vascular and hard than TA on US. KHE lesions were subcutaneous and reticular, with heterogeneous enhancement on MRI. Awareness of these features should prompt radiologists in the differential diagnosis of pediatric masses.
Collapse
Affiliation(s)
- Xia Gong
- Department of, Ultrasound, School of Medicine, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hanru Ying
- Department of, Plastic and Reconstruction Surgery, School of Medicine, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zimin Zhang
- Department of, Radiology, School of Medicine, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lizhen Wang
- Department of, Oral Pathology, School of Medicine, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jia Li
- Department of, Ultrasound, School of Medicine, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Angang Ding
- Department of, Ultrasound, School of Medicine, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lu Zhou
- Department of, Ultrasound, School of Medicine, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaoxi Lin
- Department of, Plastic and Reconstruction Surgery, School of Medicine, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ping Xiong
- Department of, Ultrasound, School of Medicine, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| |
Collapse
|
19
|
Anger J, Oliveira EMD, Gabel J. EFFECTIVENESS OF FIXED DOSES OF PROPRANOLOL IN THE TREATMENT OF HEMANGIOMAS REGARDLESS OF CHILD'S WEIGHT GAIN: A CASE REPORT. ACTA ACUST UNITED AC 2019; 37:392-395. [PMID: 31090848 PMCID: PMC6868553 DOI: 10.1590/1984-0462/;2019;37;3;00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/28/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To present the outcomes of fixed doses of propranolol tablets for the treatment of hemangiomas. CASE DESCRIPTION Two illustrative cases of hemangioma in infant patients younger than six months old are described. Treatments were started in 2010 and 2011 and were monitored until August 2017. Patients were treated with fixed doses, initially calculated based on the upper limit of 3 mg/kg/day and administrated in two daily doses rounded down to the nearest multiple of five milligrams. Dosage was not adjusted to patients' weight gain. The tablets were crushed and then diluted in a maximum amount of 3 mL of water. This procedure was necessary because propranolol was not available in oral solution in 2009, when dosages available in the Brazilian market were 10, 40 and 80 mg. Both patients presented significative improvement in the first 60 days and were in complete remission by the end of the treatment. COMMENTS It is possible to treat patients with Propranolol 10 mg tablets, even though the dosage is not as precise as when calculated according to patients' weight. The maintenance of a fixed dose, ignoring the patient's progressive weight gains, helps avoiding the rebound effect and decreases complications.
Collapse
Affiliation(s)
- Jaime Anger
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - José Gabel
- Project "Einstein na Comunidade Paraisópolis", São Paulo, SP, Brazil
| |
Collapse
|
20
|
Soft-tissue vascular malformations and tumors. Part 1: Classification, role of imaging and high-flow lesions. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2017.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
21
|
Classification and ultrasound findings of vascular anomalies in pediatric age: the essential. J Ultrasound 2018; 22:13-25. [PMID: 30488172 DOI: 10.1007/s40477-018-0342-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/24/2018] [Indexed: 01/31/2023] Open
Abstract
Proper nomenclature is a major obstacle in understanding and managing vascular anomalies. Often the same term is used for totally different types of lesions or, conversely, the same lesion may be labeled with different terms. Although in recent times there has been a greater understanding of the problems concerning vascular anomalies, episodes of improper use of terminology still remain. The aim of this article, starting from the most recent classification of vascular anomalies, is to provide a clinical and instrumental approach to identifying these lesions and to converge towards a clear and unambiguous terminology that must become univocal among the various operators to avoid diagnostic misunderstandings and therapeutic errors.
Collapse
|
22
|
Di Serafino M, Verde F, Ferro F, Vezzali N, Rossi E, Acampora C, Valente I, Pelliccia P, Speca S, Vallone G. Ultrasonography of the pediatric spleen: a pictorial essay. J Ultrasound 2018; 22:503-512. [PMID: 30446947 DOI: 10.1007/s40477-018-0341-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/09/2018] [Indexed: 12/26/2022] Open
Abstract
In infants and children, the spleen is involved in many pathological processes, whether those processes are isolated or related to systemic diseases. Pathology of the pediatric spleen includes congenital anomalies, splenomegaly, trauma, focal lesions, infarction, and tumors. Ultrasonography (US) is a widely available, fast, noninvasive imaging technique to assess the size, shape, and position of the spleen, as well as to define splenic echotexture. US is capable of screening for splenic disorders without the risk of ionizing radiation; it is the initial imaging examination performed to evaluate suspected splenic pathology, providing clinicians with helpful decisional support. US plays an important role in the detection of even very small amounts of hemoperitoneum, a herald of significant abdominal organ injury, in pediatric blunt abdominal trauma. Moreover, contrast-enhanced US may allow early detection of splenic injuries, ideally minimizing children's risk from radiation exposure. This pictorial essay illustrates the normal ultrasound appearance of the pediatric spleen and the sonographic findings which may guide clinicians to a correct diagnosis of pathologic conditions.
Collapse
Affiliation(s)
| | - Francesco Verde
- Paediatric Radiology Department, "Federico II" University Hospital, Naples, Italy.
| | - Federica Ferro
- Radiology Department, Regional Hospital of Bolzano, Bolzano, Italy
| | - Norberto Vezzali
- Radiology Department, Regional Hospital of Bolzano, Bolzano, Italy
| | - Eugenio Rossi
- Radiology Department, "Santobono-Pausilipon" Children Hospital, Naples, Italy
| | - Ciro Acampora
- Radiology Department, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Iacopo Valente
- Radiology and Neuroradiology Imaging Diagnostic Department, Agostino Gemelli" University Hospital, IRCCS, Rome, Italy
| | | | - Stefania Speca
- Department of Radiology, Sacro Cuore" University Hospital, Rome, Italy
| | - Gianfranco Vallone
- Paediatric Radiology Department, "Federico II" University Hospital, Naples, Italy
| |
Collapse
|
23
|
Mamlouk MD, Lee PW. Developing a Multidisciplinary Vascular Anomalies Clinic and Reviewing the Radiologist’s Clinic Role. Curr Probl Diagn Radiol 2018; 47:378-381. [DOI: 10.1067/j.cpradiol.2017.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 10/23/2017] [Indexed: 12/29/2022]
|
24
|
Ogu UO, Abusin G, Abu-Arja RF, Staber JM. Successful Management of Blue Rubber Bleb Nevus Syndrome (BRBNS) with Sirolimus. Case Rep Pediatr 2018; 2018:7654278. [PMID: 30402320 PMCID: PMC6196891 DOI: 10.1155/2018/7654278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 09/17/2018] [Indexed: 12/12/2022] Open
Abstract
Blue rubber bleb nevus syndrome (BRBNS) is a rare disease with vascular malformations in several systems of the body, most commonly the skin and gastrointestinal tract. Bleeding from the gastrointestinal (GI) tract is a major complication, which may lead to chronic iron deficiency anemia and the need for frequent blood transfusions due to ongoing gastrointestinal blood loss. In this case report, we describe a now 19-year-old female with BRBNS who required six blood transfusions per year and after starting sirolimus is symptom- and transfusion-free.
Collapse
Affiliation(s)
- Ugochi O. Ogu
- Division of Hematology, Department of Oncology, Montefiore Medical Center, Bronx, NY, USA
| | - Ghada Abusin
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Rolla F. Abu-Arja
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH, USA
| | - Janice M. Staber
- Division of Pediatric Hematology/Oncology, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| |
Collapse
|
25
|
Soft-tissue vascular malformations and tumors. Part 1: classification, role of imaging and high-flow lesions. RADIOLOGIA 2018; 61:4-15. [PMID: 30292467 DOI: 10.1016/j.rx.2017.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 11/08/2017] [Accepted: 11/11/2017] [Indexed: 01/05/2023]
Abstract
Vascular malformations and tumors, also known as "vascular anomalies", comprise an extensive variety of lesions involving all parts of the body. Knowledge of their classification and imaging characteristics is paramount. Whereas hemangiomas are benign vascular tumors, characterized by cellular proliferation and hyperplasia; vascular malformations are not real tumors and characteristically exhibit normal endothelial turnover. Vascular malformations are classified according to the predominant vascular channel as arterial, capillary, venous, lymphatic, or mixed. Ultrasound and MRI are the main imaging modalities used in the diagnosis and classification of the vascular anomalies. In this series of two articles we review the classification of vascular anomalies, describe the role of imaging, summarize their distinctive histopathogenic, clinical and imaging features, and discuss the treatment options. On the first article we discuss the high-flow lesions, whereas the slow-flow lesions will be reviewed on the second. Complex syndromes with associated vascular tumors and malformations will be also presented.
Collapse
|
26
|
A Rare Case of Gallbladder and Common Bile Duct Benign Capillary Hemangioma in a Toddler. J Pediatr Gastroenterol Nutr 2018; 67:e58-e60. [PMID: 29652727 DOI: 10.1097/mpg.0000000000002003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
27
|
Masand PM. Magnetic resonance imaging features of common focal liver lesions in children. Pediatr Radiol 2018; 48:1234-1244. [PMID: 30078045 DOI: 10.1007/s00247-018-4218-5] [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: 03/26/2018] [Revised: 07/06/2018] [Accepted: 07/17/2018] [Indexed: 12/29/2022]
Abstract
Magnetic resonance imaging (MRI) is commonly used to characterize focal liver masses in the pediatric population. MRI is the preferred modality because of its superior contrast resolution and utility for obtaining functional sequences such as diffusion-weighted imaging (DWI). MR exams performed with a hepatocyte-specific gadolinium-based contrast agent can characterize focal liver lesions, which helps in differentiating a common benign entity such as focal nodular hyperplasia from other liver pathology when the background liver is normal. The most common benign focal lesion is a hemangioma, and metastases followed by hepatoblastoma are the most common malignant lesions. This article can help radiologists become familiar with the pre- and post-contrast imaging features of common pediatric liver masses.
Collapse
Affiliation(s)
- Prakash M Masand
- Cardiovascular Imaging, Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St., Houston, TX, 77030, USA. .,Baylor College of Medicine, Houston, TX, USA.
| |
Collapse
|
28
|
Johnson CM, Navarro OM. Clinical and sonographic features of pediatric soft-tissue vascular anomalies part 1: classification, sonographic approach and vascular tumors. Pediatr Radiol 2017; 47:1184-1195. [PMID: 28779195 DOI: 10.1007/s00247-017-3885-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/19/2017] [Accepted: 04/28/2017] [Indexed: 01/21/2023]
Abstract
Sonography can be used in the management of pediatric soft-tissue vascular anomalies for diagnosing, for assessing lesion extent and for evaluating complications and response to therapy. The sonographic technique includes a combination of gray-scale imaging with color and spectral Doppler techniques. However the interpretation of the sonographic findings requires correlation with the clinical findings, some of which can be easily obtained at the time of scanning. This has to be combined with the use of appropriate nomenclature and the most updated classification in order to categorize these children into the appropriate management pathway. In this article, which is part 1 of a two-part series, the authors review the current classification of vascular anomalies, provide a clinical and a sonographic approach to these lesions, and review the most relevant clinical and sonographic features of vascular tumors including infantile and congenital hemangiomas, tufted angioma, kaposiform hemangioendothelioma, pyogenic granuloma, intramuscular capillary-type hemangioma and angiosarcoma.
Collapse
Affiliation(s)
- Craig M Johnson
- Division of Interventional Radiology, Department of Radiology, Nemours Children's Hospital, Orlando, FL, USA
| | - Oscar M Navarro
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada. .,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
29
|
Enhanced expression of Programmed cell death 1 (PD-1) protein in benign vascular anomalies. Pathology 2017; 49:292-296. [PMID: 28238417 DOI: 10.1016/j.pathol.2016.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/14/2016] [Accepted: 10/20/2016] [Indexed: 11/24/2022]
Abstract
Programmed cell death 1 (PD-1) and its ligands have been shown to play a significant role in evasion of malignant tumour cells from the immune system. Last year, the United States Food and Drug Administration (FDA) approved anti-PD-1 inhibitors for treatment of non-small cell lung carcinoma and recently has approved anti-PD-L1 blocker for treatment of metastatic urothelial cell carcinoma. However, the role that the immune system might have on benign tumours including vascular anomalies has received less attention. In this study, we evaluated PD-1 and PD-L1 expression on two benign vascular anomalies: infantile haemangiomas and venous malformations. Tissue microarrays (TMAs) from these two entities were stained for PD-1 and PD-L1 antibodies. Blood vessels from normal tissue were used as control. The endothelial cells in both infantile haemangioma and venous malformation showed high expression of PD-1 but were negative for PD-L1. Endothelial cells within the blood vessels in normal tissues were negative for both PD-1 and PD-L1. Our results showed over-expression of PD-1 in subsets of vascular anomalies, while PD-L1 was negative. This would raise the possibility of immunotherapy in benign vascular tumour when other options are exhausted.
Collapse
|
30
|
Archontaki S, Vial Y, Hanquinet S, Meuli R, Alamo L. Magnetic resonance imaging of fetal pelvic cysts. Abdom Radiol (NY) 2016; 41:2445-2454. [PMID: 27909773 DOI: 10.1007/s00261-016-0980-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The detection of fetal anomalies has improved in the last years as a result of the generalization of ultrasound pregnancy screening exams. The presence of a cystic imaging in the fetal pelvis is a relatively common finding, which can correspond to a real congenital cystic lesion or result from the anomalous liquid accumulation in a whole pelvic organ, mainly the urinary bladder, the uterus, or the vagina. In selected cases with poor prognosis and/or inconclusive echographic findings, magnetic resonance may bring additional information in terms of the characterization, anatomical location, and real extension of the pathology. This pictorial essay describes the normal pelvic fetal anatomy, as well as the most common pelvic cysts. It also describes the causes of an anomalous distension of the whole pelvic organs detected in utero, with emphasis on prenatal magnetic resonance imaging exams. Moreover, it proposes practical teaching points to reduce the differential diagnosis of these lesions based on the sex of the fetus, the division of the pelvis in anatomical spaces, and the imaging findings of the pathology. Finally, it discusses the real utility of complementary MRI.
Collapse
Affiliation(s)
- Styliani Archontaki
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne (CHUV), Rue du Bugnon, 46, Lausanne, 1011, Switzerland
- Department of Radiology, Hospital of Yverdon, Rue d'Entremonts 11, Yverdon-les-Bains, 1400, Switzerland
| | - Yvan Vial
- Department of Gynecology and Obstetrics, University Hospital of Lausanne (CHUV), Rue du Bugnon, 46, Lausanne, 1011, Switzerland
| | - Sylviane Hanquinet
- Department of Pediatric Radiology, University Hospital of Geneve (HUG), Rue Willy-Donzé 6, Geneva, 1205, Switzerland
| | - Reto Meuli
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne (CHUV), Rue du Bugnon, 46, Lausanne, 1011, Switzerland
| | - Leonor Alamo
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne (CHUV), Rue du Bugnon, 46, Lausanne, 1011, Switzerland.
| |
Collapse
|
31
|
Aronniemi J, Lohi J, Salminen P, Vuola P, Lappalainen K, Pitkäranta A, Pekkola J. Angiomatosis of soft tissue as an important differential diagnosis for intramuscular venous malformations. Phlebology 2016; 32:474-481. [PMID: 27688038 DOI: 10.1177/0268355516671463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background We aimed to improve management of extremity low-flow vascular malformations by analyzing the histology and imaging of venous malformations (VMs) not responsive to sclerotherapy. Method We reviewed patient records of 102 consecutive patients treated with sclerotherapy for extremity VM in our institution to identify patients who had undergone surgery due to insufficient response. We semi-quantitatively analysed the tissue specimens and compared histological findings to those in preoperative imaging. Result The number of patients operated on was 19 (18.6%); 15 of them had lower-extremity intramuscular lesions. The histological pattern of 13 of these 15 lesions corresponded to angiomatosis of soft tissue (AST). All other lesions treated surgically were VMs. The histology of AST was distinctive but magnetic resonance imaging findings often overlapped with those of VM. Conclusion AST is easily mixed with intramuscular VM. The differentiation of these two entities has therapeutic importance. We emphasize the role of histology in the differential diagnostics of intramuscular slow-flow vascular malformations.
Collapse
Affiliation(s)
- Johanna Aronniemi
- 1 University of Helsinki, Helsinki, Finland.,2 Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Jouko Lohi
- 1 University of Helsinki, Helsinki, Finland.,3 Department of Pathology, HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - Päivi Salminen
- 1 University of Helsinki, Helsinki, Finland.,4 Department of Pediatric Surgery, Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Pia Vuola
- 1 University of Helsinki, Helsinki, Finland.,5 Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Kimmo Lappalainen
- 1 University of Helsinki, Helsinki, Finland.,2 Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Anne Pitkäranta
- 1 University of Helsinki, Helsinki, Finland.,6 Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, Institute of Clinical Medicine, Helsinki, Finland
| | - Johanna Pekkola
- 1 University of Helsinki, Helsinki, Finland.,2 Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
32
|
Pulmonary haemangiolymphangioma as cause of hemodynamic decompensation. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2016. [DOI: 10.1016/j.hgmx.2016.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
33
|
Mamlouk MD, Hess CP. Arterial spin-labeled perfusion for vascular anomalies in the pediatric head and neck. Clin Imaging 2016; 40:1040-6. [DOI: 10.1016/j.clinimag.2016.06.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/13/2016] [Accepted: 06/16/2016] [Indexed: 11/28/2022]
|
34
|
Aronniemi J, Castrén E, Lappalainen K, Vuola P, Salminen P, Pitkäranta A, Pekkola J. Sclerotherapy complications of peripheral venous malformations. Phlebology 2016; 31:712-722. [PMID: 26494223 DOI: 10.1177/0268355515613740] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Sclerotherapy is often the primary treatment for peripheral venous malformations. It is mostly sufficient alone, but can be combined with other endovascular techniques. Despite its mini-invasiveness, it is not without potentially severe complications. Here, we systematically report sclerotherapy complications in trunk and extremity venous malformations. Methods We retrospectively assessed the complications of 127 consecutive patients who had received sclerotherapy for peripheral venous malformation in our tertiary care unit (January 2007-August 2013). We applied the Clavien-Dindo classification to grade the severity of complications. We mostly used detergent sclerosants (85.7%), and less often ethanol (5.7%) or bleomycin (4.2%). In 4.2% of the procedures, we combined glue, coils, endovascular laser or particles to sclerotherapy. Results The overall complication rate per procedure was 12.5%. Most complications (83.3%) were local and managed conservatively. We encountered four severe complications, all related to blood coagulopathy. Subcutaneous lesion location and use of ethanol significantly increased the risk of local complications. Conclusion Sclerotherapy alone or combined with other endovascular techniques is a safe method for local venous malformations with moderate risk for conservatively manageable complications. Blood coagulopathy constitutes a risk for, otherwise rare, severe complications.
Collapse
Affiliation(s)
- Johanna Aronniemi
- 1 Department of Radiology, University of Helsinki, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Eeva Castrén
- 2 Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
| | - Kimmo Lappalainen
- 1 Department of Radiology, University of Helsinki, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Pia Vuola
- 3 Department of Plastic Surgery, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
| | - Päivi Salminen
- 4 Department of Pediatric Surgery, University of Helsinki, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Anne Pitkäranta
- 2 Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
| | - Johanna Pekkola
- 1 Department of Radiology, University of Helsinki, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
| |
Collapse
|
35
|
Torres E, Rosa J, Leaute-Labreze C, Soares-de-Almeida L. Multifocal infantile haemangioma: a diagnostic challenge. BMJ Case Rep 2016; 2016:bcr-2016-214827. [PMID: 27317759 DOI: 10.1136/bcr-2016-214827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe a case of a newborn who presented with multiple dark red macules that developed into red-to-purple papules associated with thrombocytopaenia. Abdominal ultrasound showed multiple hyperechoic papules and nodules. Endothelial cells from a skin biopsy stained positively for endothelial cell glucose transporter 1, which was consistent with a diagnosis of multifocal infantile haemangioma. At the age of 2 months, the child developed intestinal bleeding and anaemia. Upper and lower endoscopies showed no intestinal haemangiomas. Oral treatment with propranolol (3 mg/kg/day) resulted in complete involution of the skin and hepatic haemangiomas over the period of treatment, which lasted until the child was aged 15 months. This is a rare case of multifocal cutaneous haemangioma with hepatic and probable intestinal involvement, successfully treated with propranolol.
Collapse
Affiliation(s)
- Erica Torres
- Serviço de Pediatria, Hospital Faro, Centro Hospitalar Algarve, Faro, Portugal
| | - João Rosa
- Serviço de Pediatria, Hospital Faro, Centro Hospitalar Algarve, Faro, Portugal
| | | | - Luis Soares-de-Almeida
- Department of Dermatology, Hospital de Santa Maria-Centro Hospitalar de Lisboa Norte, Lisbon, Portugal
| |
Collapse
|
36
|
Yesil S, Tanyildiz HG, Bozkurt C, Cakmakci E, Sahin G. Single-center experience with sirolimus therapy for vascular malformations. Pediatr Hematol Oncol 2016; 33:219-25. [PMID: 27128161 DOI: 10.3109/08880018.2016.1160170] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Vascular malformations (VMs) are described as congenital malformations of the vasculature derived from capillaries, veins, lymphatic vessels, arteries, or a combination of these vessels. They can cause significant morbidity resulting from soft tissue hypertrophy-related disfiguration, bony abnormalities, and even organ compromise. They are usually treated with various interventional procedures to achieve local control; however, the chance of success decreases as the anatomical distribution of the malformation widens. Unfortunately, medical treatment options have been quite limited in these patients. Sirolimus is an antiangiogenetic and antiproliferative pharmacologic agent that has been used for the management of VM in the last decade. We report 6 pediatric patients (4 with capillary lymphaticovenous malformations, 1 with lymphaticovenous malformation, and 1 with venous malformation) seen at our clinic within the last 2 years with lesions covering wide anatomical areas. After the patients had unsuccessfully undergone various treatments at various centers, they were treated at our facility with peroral sirolimus. The mean duration of treatment was 13 months, but in 3 patients, tapered dosing continues. Five patients achieved partial responses. The response to sirolimus treatment increased as the lymphatic component of the VM increased. All patients tolerated sirolimus well; side effects were acceptable. Sirolimus is a safe and effective medical treatment for widely distributed VMs with significant lymphatic components and no further local treatment option.
Collapse
Affiliation(s)
- Sule Yesil
- a Department of Pediatric Oncology and Hematology , Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
| | - Hikmet Gulsah Tanyildiz
- a Department of Pediatric Oncology and Hematology , Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
| | - Ceyhun Bozkurt
- a Department of Pediatric Oncology and Hematology , Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
| | - Emin Cakmakci
- b Department of Radiology , Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
| | - Gurses Sahin
- a Department of Pediatric Oncology and Hematology , Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital , Ankara , Turkey
| |
Collapse
|
37
|
Duarte AF, Valera E, Chahud F, Cruz AAV. Infantile Primary Orbital Angiosarcoma. Pediatr Blood Cancer 2016; 63:752-3. [PMID: 26599256 DOI: 10.1002/pbc.25846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 10/22/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Ana F Duarte
- Division of Oculoplastic and Orbit, Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery of the School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Elvis Valera
- Department of Pediatrics of the School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Fernando Chahud
- Department of Pathology of the School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Antonio Augusto Velasco Cruz
- Division of Oculoplastic and Orbit, Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery of the School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
38
|
Early experience with X-ray magnetic resonance fusion for low-flow vascular malformations in the pediatric interventional radiology suite. Pediatr Radiol 2016; 46:413-21. [PMID: 26681438 DOI: 10.1007/s00247-015-3485-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 08/02/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
Abstract
This technical innovation describes our experience using an X-ray magnetic resonance fusion (XMRF) software program to overlay 3-D MR images on real-time fluoroscopic images during sclerotherapy procedures for vascular malformations at a large pediatric institution. Five cases have been selected to illustrate the application and various clinical utilities of XMRF during sclerotherapy procedures as well as the technical limitations of this technique. The cases demonstrate how to use XMRF in the interventional suite to derive additional information to improve therapeutic confidence with regards to the extent of lesion filling and to guide clinical management in terms of intraprocedural interventional measures.
Collapse
|
39
|
Classification and Tie2 mutations in spinal and soft tissue vascular anomalies. Gene 2015; 571:91-6. [DOI: 10.1016/j.gene.2015.06.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/09/2015] [Accepted: 06/19/2015] [Indexed: 11/24/2022]
|
40
|
Nassiri N, Rootman J, Rootman DB, Goldberg RA. Orbital lymphaticovenous malformations: Current and future treatments. Surv Ophthalmol 2015; 60:383-405. [DOI: 10.1016/j.survophthal.2015.03.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 03/02/2015] [Accepted: 03/06/2015] [Indexed: 12/23/2022]
|
41
|
Imaging evaluation of fetal vascular anomalies. Pediatr Radiol 2015; 45:1218-29. [PMID: 25492302 DOI: 10.1007/s00247-014-3248-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 09/29/2014] [Accepted: 11/17/2014] [Indexed: 02/06/2023]
Abstract
Vascular anomalies can be detected in utero and should be considered in the setting of solid, mixed or cystic lesions in the fetus. Evaluation of the gray-scale and color Doppler US and MRI characteristics can guide diagnosis. We present a case-based pictorial essay to illustrate the prenatal imaging characteristics in 11 pregnancies with vascular malformations (5 lymphatic malformations, 2 Klippel-Trenaunay syndrome, 1 venous-lymphatic malformation, 1 Parkes-Weber syndrome) and vascular tumors (1 congenital hemangioma, 1 kaposiform hemangioendothelioma). Concordance between prenatal and postnatal diagnoses is analyzed, with further discussion regarding potential pitfalls in identification.
Collapse
|
42
|
Wassef M, Blei F, Adams D, Alomari A, Baselga E, Berenstein A, Burrows P, Frieden IJ, Garzon MC, Lopez-Gutierrez JC, Lord DJE, Mitchel S, Powell J, Prendiville J, Vikkula M. Vascular Anomalies Classification: Recommendations From the International Society for the Study of Vascular Anomalies. Pediatrics 2015; 136:e203-14. [PMID: 26055853 DOI: 10.1542/peds.2014-3673] [Citation(s) in RCA: 739] [Impact Index Per Article: 82.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2015] [Indexed: 12/13/2022] Open
Abstract
Vascular anomalies represent a spectrum of disorders from a simple "birthmark" to life- threatening entities. Incorrect nomenclature and misdiagnoses are commonly experienced by patients with these anomalies. Accurate diagnosis is crucial for appropriate evaluation and management, often requiring multidisciplinary specialists. Classification schemes provide a consistent terminology and serve as a guide for pathologists, clinicians, and researchers. One of the goals of the International Society for the Study of Vascular Anomalies (ISSVA) is to achieve a uniform classification. The last classification (1997) stratified vascular lesions into vascular malformations and proliferative vascular lesions (tumors). However, additional disease entities have since been identified that are complex and less easily classified by generic headings, such as capillary malformation, venous malformation, lymphatic malformation, etc. We hereby present the updated official ISSVA classification of vascular anomalies. The general biological scheme of the classification is retained. The section on tumors has been expanded and lists the main recognized vascular tumors, classified as benign, locally aggressive or borderline, and malignant. A list of well-defined diseases is included under each generic heading in the "Simple Vascular Malformations" section. A short definition is added for eponyms. Two new sections were created: one dealing with the malformations of individually named vessels (previously referred to as "truncular" malformations); the second groups lesions of uncertain or debated nature (tumor versus malformation). The known genetic defects underlying vascular anomalies are included in an appendix. This classification is meant to be a framework, acknowledging that it will require modification as new scientific information becomes available.
Collapse
Affiliation(s)
- Michel Wassef
- Assistance Publique-Hopitaux de Paris, Lariboisière Hospital, Department of Pathology, Paris Diderot University, Paris, France;
| | - Francine Blei
- Vascular Birthmark Program, Lenox Hill Hospital of North Shore Long Island Jewish Healthcare System, New York, New York
| | - Denise Adams
- Cincinnati Children's Hospital Medical Center, Cancer and Blood Disease Institute, University of Cincinnati, Cincinnati, Ohio
| | - Ahmad Alomari
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eulalia Baselga
- Pediatric Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Patricia Burrows
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ilona J Frieden
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Maria C Garzon
- Department of Dermatology, Columbia University, New York, New York
| | | | - David J E Lord
- Interventional Radiology, Sydney Children's Hospitals Network, Sydney, Australia
| | - Sally Mitchel
- Departments of Radiology, Surgery, and Pediatrics, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Julie Powell
- Division of Dermatology (Pediatrics), Centre Hospithalier Universitaire Sainte-Justine, University of Montreal, Montreal, Canada
| | - Julie Prendiville
- Pediatric Dermatology, University of British Columbia, Vancouver, Canada; and
| | - Miikka Vikkula
- Laboratory of Human Molecular Genetics, Christian de Duve Institute of Cellular Pathology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | | |
Collapse
|
43
|
Otero HJ, Rubio E, Blask A. Ovary and testicle and everything in between: lesions and imaging in the newborn. Semin Ultrasound CT MR 2015; 36:178-92. [PMID: 26001946 DOI: 10.1053/j.sult.2015.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Assessment of the neonatal reproductive tract requires an understanding of embryology, awareness of common clinical presentations, and familiarity with normal newborn variation. This review of the neonatal reproductive tract emphasizes the use of sonography in the evaluation of developmental, acquired, and neoplastic conditions in male and female newborns. Anchored in embryologic origins, the discussion also includes descriptions of findings that may be encountered in prenatal imaging. Comments on clinical correlation are included to guide appropriate triaging of these complex cases. Imaging pearls and pitfalls are incorporated into this review, including the recognized effects of maternal hormones in female infants.
Collapse
Affiliation(s)
- Hansel J Otero
- Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC.
| | - Eva Rubio
- Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC
| | - Anna Blask
- Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC
| |
Collapse
|
44
|
Epelman M, Johnson C, Hellinger JC, Darge K, Newman B. Vascular Lesions—Congenital, Acquired, and Iatrogenic: Imaging in the Neonate. Semin Ultrasound CT MR 2015; 36:193-215. [DOI: 10.1053/j.sult.2015.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
45
|
Oca Pernas R, Prada González R, Santos Armentia E, Hormaza Aguirre N, Tardáguila de la Fuente G, Trinidad López C, Delgado Sánchez-Gracián C. Benign soft-tissue lesions of the fingers: radiopathological correlation and clinical considerations. Skeletal Radiol 2015; 44:477-90. [PMID: 25367671 DOI: 10.1007/s00256-014-2040-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 09/13/2014] [Accepted: 10/15/2014] [Indexed: 02/02/2023]
Abstract
Soft-tissue lesions of the fingers are commonly found in daily clinical practice. A wide range of tumors and pseudotumors have been described in this location, and the majority of them are benign. Ganglion cysts are the most common entity, and the localized type of tenosynovial giant cell tumors are the most frequent solid condition. Both may be easily recognized owing to their typical clinical and radiological characteristics. However, categorization of the spectrum of soft-tissue lesions of the fingers remains limited, despite imaging development, and many patients undergo surgery before radiological or histological diagnosis. Clinical history, radiographic features, and ultrasound and magnetic resonance patterns may help in obtaining the correct diagnosis or reducing the list of differential diagnoses. Radiologists should be familiar with imaging findings so that they can determine the size, extension, and affected neighboring anatomical structures, and provide information that allows adequate presurgical counseling.
Collapse
Affiliation(s)
- Roque Oca Pernas
- Radiology Department, Povisa Hospital, Salamanca S/N, 36211, Vigo, Spain,
| | | | | | | | | | | | | |
Collapse
|
46
|
Tranvinh E, Yeom KW, Iv M. Imaging Neck Masses in the Neonate and Young Infant. Semin Ultrasound CT MR 2015; 36:120-37. [DOI: 10.1053/j.sult.2015.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
47
|
Castrén E, Aronniemi J, Klockars T, Pekkola J, Lappalainen K, Vuola P, Salminen P, Pitkäranta A. Complications of sclerotherapy for 75 head and neck venous malformations. Eur Arch Otorhinolaryngol 2015; 273:1027-36. [DOI: 10.1007/s00405-015-3577-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/23/2015] [Indexed: 12/13/2022]
|
48
|
Abstract
Vascular anomalies (VAs) comprise a large variety of individual diagnoses that in different phases of treatment require a diverse number of medical specialists to provide optimal care. Medical therapies include agents usually associated with cancer chemotherapy, such as vincristine, as well more immunomodulatory types of drugs, such as glucocorticoids and sirolimus. These immunomodulating drugs are being successfully applied in cases that are typically categorized as vascular tumors, including kaposiform hemangioendothelioma (KHE) and tufted angioma (TA), as well as some of the more invasive types of vascular malformations (i.e., microcystic lymphatic malformations and blue rubber bleb nevus syndrome (BRBNS). These therapies need to be combined with good supportive care, which often involves anticoagulation, antimicrobial prophylaxis, and comprehensive pain and symptom-relief strategies, as well as appropriate drug monitoring and management of side effects of medical treatment. The optimal care of these patients frequently involves close collaboration between surgeons, interventional and conventional radiologists, medical subspecialists, and nurses.
Collapse
Affiliation(s)
- Judith F Margolin
- Baylor College of Medicine, Texas Children's Cancer and Hematology Service, Houston, Texas
| | - Heather Mills Soni
- Baylor College of Medicine, Texas Children's Cancer and Hematology Service, Houston, Texas
| | - Sheena Pimpalwar
- Division of Interventional Radiology, Department of Radiology, TCH, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
49
|
Abstract
Imaging of patients with vascular tumors and malformations has been sufficiently refined to answer pertinent questions when making treatment decisions in this challenging subgroup of pediatric patients. The imaging modalities at hand include conventional radiography, Doppler ultrasound, and magnetic resonance imaging with time-resolved, contrast-material enhanced magnetic resonance angiography. This review article will focus on the characteristic imaging features of some focal and diffuse vascular lesions, which have been classified by their clinical history and physical exam, and further labeled as a vascular tumor or slow-flow versus high-flow vascular malformation based on the updated classification system proposed by the International Society for the Study of Vascular Anomalies. The recent advances in knowledge regarding the biology of these vascular anomalies have led to increased awareness of the current nomenclature. Moreover, with better understanding of the imaging features, the radiologist has become a key player in the multidisciplinary approach offered at various institutions where appropriate treatment algorithms and interventional strategies are put together. This is crucial in avoiding misdiagnosis and improper management.
Collapse
Affiliation(s)
- Prakash Masand
- Department of Pediatric Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| |
Collapse
|