2015 HSC Section 1 Book of Articles

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

Figure 15 (a) Foot and lower leg of 24-year-old man with Parkes e Weber. Note thickened skin lesions as outlined by white arrows. Similar changes are also noted in the anterior lower shin. (b) Lateral arteriogram of foot from popliteal injection. Note hypervascularity of AVM nidus (white arrows) underneath the thickened skin lesions on photo (a). Note that the dorsalis pedis artery is the feeding artery (black arrow). The posterior tibial artery (arrowhead) is marked for orientation purposes. (c) Selective arterial phase on dorsum of foot on lateral view. Note the catheter in the dorsalis pedis artery (black arrow). The AVM nidus (white arrows) demonstrates early arterial enhancement with an early draining vein (arrowhead). (d) Selective arterial phase on dorsum of foot on anteroposterior view. Note microcatheter in the distal part of the feeding artery (black arrow) supplying the nidus of the AVM (white arrows). The draining vein is marked with the arrowhead.

lead to pain, bleeding, and skin breakdown. In some cases, they can result in high-output cardiac failure. Diagnosis can be made by MRI or CT angiography. Biopsy should be avoided because of the high risk of bleeding. Treatment typically involves transcatheter embolization, with or without additional modalities. 38,39 Digital subtraction angiography is useful in precise demonstration of the arterial feeders and venous drainage pathways for pre- embolization planning. AVMs are clinically classi fi ed by the Schobinger scale of AVM severity ( Table 3 ). 40 Grey-scale evaluation of AVMs demonstrates a tangle of vessels with no associated mass. Doppler evaluation shows arterial fl ow within the vessels, with prominent draining vessels with high fl ow as well. MRI

re fl ects this high fl ow state by prominent fl ow-related signal voids, as well as easier visualization of feeding and draining vessels. MRA/MRV is frequently helpful in pre- procedural planning for these lesions. Pathology demonstrates beds of venules and arterioles, intermixed with numerous larger-calibre arteries and thick- walled veins.

Complex malformations

Lymphaticovenous malformation Lymphaticovenous malformations (LVMs) are slow- fl ow lesions that contain both lymphatic and venous ele- ments. 41 In the authors ’ experience, these lesions are rare,

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