2015 HSC Section 1 Book of Articles

A. Tekes et al. / Clinical Radiology 69 (2014) 443 e 457

Figure 14 (a) A 20-year-old man with bluish lesion in left lower fl ank since birth. Similar lesions were also noted on the buttocks, right and left thighs, left wrist, and right forearm (not shown). These were painful when pushed on. His father had similar lesion on his left forearm. Note they are cutaneous and subcutaneous, raised lesions with some fi rmness, yet compressible. (b) Coronal T2 weighted image shows lobular T2-bright lesion in the subcutaneous fat. (c) Ultrasound during needle access for sclerotherapy. Lesion had fi rm borders but extensive venous spaces. No fl ow seen on power Doppler (not shown). (d) Percutaneous venogram of lesion during sclerotherapy treatment. Based on MRI only, diagnosis of glomuvenous malformation is very dif fi cult as imaging features overlap with that of a VM. Presence of similar lesions in the patient ’ s father along with super fi cial location and painful nature are very helpful in establishing the diagnosis of a glomuvenous malformation.

example, midline posterior CMs may be associated with tethered spinal cord. Facial CMs may be associated with Sturge e Weber syndrome, particularly in the V1 distribution ( Fig 8 ). Patients with V1 distribution CMs should undergo early neurological and ophthalmological evaluation. Pa- tients with V2 and V3 involvement are generally not at risk. Other conditions associated with CMs include Klip- pel e Trenaunay (KT), Parkes e Weber syndrome. CMs may be associated with underlying arteriovenous malformations (AVMs) as part of the RASA1 mutation. 20 CMs associated with Sturge e Weber have a tendency to become thickened and lobulate with age. Early intervention with pulsed dye laser to the CM may prevent progression towards more nodular growth. 35,36 These are very dif fi cult to treat once hypertrophy has occurred and may require dif fi cult and repeated plastic surgical procedures to keep the enlargement under control. Angiography rarely

demonstrates enough visible hypervascularity to render embolization an alternative to controlling this growth. In addition, there may be bony overgrowth that cannot be controlled. MRI demonstrates the super fi cial thickening. 37

Fast- fl ow malformations

Arteriovenous malformation AVMs and arteriovenous fi stulas are pulsatile lesions without a mass and without the capillary transition be- tween artery and vein, typically with associated bruit or murmur ( Figs 1 and 9 ). They present in early childhood and grow with the child. They may also undergo periods of more rapid growth, associated with growth spurts and puberty as well as occurring after trauma, pregnancy, or surgery. They can be complicated by arterial steal in affected extremities. Venous congestion from AVMs can

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