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Venous Malformation - Radiology

last modified on: Thu, 05/02/2024 - 12:46

updated by Piper Wenzel, BS May 2024

  • Defined as a "soft, non-pulsating, compressible lesion that swells when the central venous pressure rises" (Leyman 2023)
  • Also known as cavernous malformation, cavernous hemangioma, venous vascular malformation
  • Most common vascular malformation, present in 1 in 5,000 people (Ryu 2019)
  • May be painful due to congestion or thrombi within the lesion (Leyman 2023)
  • Skin or mucosa overlying the venous malformation may be blue in color or normal (Leyman 2023)
  • Phleboliths (calcified thrombi) are pathognomonic (Leyman 2023)
  • Doppler ultrasonography can be helpful in identifying the type of vascular anomaly (Ryu 2019)
  • Treatment may involve sclerotherapy, surgical resection, or laser-therapy if lesion is superficial (Leyman 2023)
  • On CT: soft tissue mass with phleboliths noted on non-contrast studies, fat hypertrophy and osseous remodeling in adjacent structures
    • Contrast-CT: variable enhancement based on flow through the malformation - fast flow gives high density
  • MR:
    • T1: hypo- to isointense signal and fat hypertrophy
    • T2: high signal with differing apprearance based on vein diameter, phleboliths appear as dropped signal
    • T1 post-contrast MR: highly variable signal - hypo- to hyperintense, homogenous or heterogeneous signal

T1-weighted MR

VVM_T1_0719

T2-weighted MR

VVM_T2_0719.

TI post-con fat-sat

VVM_T1post_0719

References

Ryu JY, Eo PS, Lee JS, Lee JW, Lee SJ, Lee JM, Lee SY, Huh S, Kim JY, Chung HY. Surgical approach for venous malformation in the head and neck. Arch Craniofac Surg. 2019 Oct;20(5):304-309. doi: 10.7181/acfs.2019.00416. Epub 2019 Oct 20. PMID: 31658794; PMCID: PMC6822077.

Kumar B, Chandra SR, Nair S, Shah AK. Case Reviews in Head and Neck Vascular Lesion Management. Oral Maxillofac Surg Clin North Am. 2024 Feb;36(1):81-92. doi: 10.1016/j.coms.2023.09.003. Epub 2023 Sep 28. PMID: 37777468.

Leyman B, Govaerts D, Dormaar JT, Meeus J, Bila M, Coropciuc R, Willaert R, Politis C. A 16-year retrospective study of vascular anomalies in the head and neck region. Head Face Med. 2023 Aug 1;19(1):32. doi: 10.1186/s13005-023-00376-z. PMID: 37528467; PMCID: PMC10391867.