CASE 97
By: Dr. Aliya Sarhan Al Barwani
HISTORY: 18-years-old with soft tissue swelling in the distal forearm
What are the findings?
What is the diagnosis?
How we treat this lesion?
FINDINGS:
· Frontal Plain-Radiograph of forearm: Soft tissue mass in the distal forearm with focal calcification (Phlebolith).
· MRI: Well define lobulated soft tissue mass in the inter-osseous space between the distal radius and ulna. The lesion is low in signal in coronal T1WI and high in signal in T2WI with focal area of signal void. Post contrast Sag T1 shows avid enhancement. No adjacent perilesional edema. No cortical erosion.
DIAGNOSIS:
Low flow venous tumor/Hemangioma.
Treatment is by Sclerotherapy.
PEARLS AND DISCUSSION:
Haemangioma is also known as low flow venous malformation. It is commonly seen in young female as soft tissue mass. It may cause osseous involvement, and when seen in muscles associated muscle atrophy is not uncommon. Five histological subtypes according to vascular channel identified within them:
1. Capillary-commonest, common in the pediatric patients.
2. Cavernous.
3. Arteriovenous.
4. Venous.
5. Mixed.
Vascular malformations are subcategorized according to their flow dynamics as:
· Low-flow vascular malformations (venous, lymphatic, capillary, capillary-venous, and capillary-lymphatic-venous).
· High-flow vascular malformations (arteriovenous malformations [AVMs] and arteriovenous fistulas [AVFs].
FURTHER READING:
1. A Pourbagher and M A Pourbagher. MRI manifestations of soft-tissue haemangiomas and accompanying reactive bone changes. Br J Radiol. (2011)
2. Ly JQ and Sanders TG. Osseous change adjacent to soft-tissue hemangiomas of the extremities: correlation with lesion size and proximity to bone. Am J Roentgenol. (2003)
3. Griffin N and Khan N. The radiological manifestations of intramuscular haemangiomas in adults: magnetic resonance imaging, computed tomography and ultrasound appearances. Skeletal Radiol. (2007)
4. Teo EL and Strouse PJ. MR imaging differentiation of soft-tissue hemangiomas from malignant soft-tissue masses. AJR Am J Roentgenol. (2000)
