Vascular Malformations




Congenital Venous Malformation, Intramuscular Hemangioma, Low-Flow Vascular Malformation


CLINICAL SUMMARY


Congenital vascular malformations can be found in any organ. Intramuscular lesions, often described as intramuscular hemangiomas , are easily recognized on MRI. In the absence of significant symptoms, only observation is required.


DIAGNOSTIC FEATURES


















History


  • The majority of intramuscular lesions present between 20 and 40 years of age



  • Cutaneous lesions are often apparent at birth



  • Intramuscular lesions are associated with activity-related pain



  • Some patients have periodic swelling and pain

Location


  • Can be located in any muscle



  • Treatment is more common for lower-extremity lesions

MRI


  • Fatty replacement of muscle on T1



  • Dilated, serpentine vascular channels on T2



  • Punctate calcification (phleboliths) on radiographs




IMAGING




























  • Clinical photo demonstrates a large mass ( arrows ) overlying the distal forearm ( left ). Most patients report a long history of mass or symptoms. This mass had been present for nearly 20 years.



  • Low-flow vascular malformation in a child’s right foot ( right ) is visible as plantar fullness with subcutaneous bluish discoloration ( arrows ).










  • Pathognomonic phleboliths ( arrows ) are seen in a proximal forearm low-flow vascular malformation. These are seen in 30% to 50% of cases and appear as smooth, round, peripherally calcified lesions less than 1 cm in size ( left ).



  • Contrast-enhanced CT scan shows a large periscapular intramuscular lesion ( right ). Large arrows point to serpentine vessels, small arrows point to fatty overgrowth, and the arrowhead points to a phlebolith.


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