The use of interstitial echo-guided diode laser 980-nm for deep vascular anomalies in pediatric patients: a preliminary study

A wide range of therapeutic options is available to treat vascular anomalies, arising from the systemic therapies to surgery or using lasers. The purpose of this preliminary study is to assess the effectiveness of treatment of vascular anomalies anywhere in the body, along with the use of interstitial echo-guided 980 nm diode laser. The analysis occurs through accurate angio magnetic resonance imaging (MRI) pre- and post-treatment measurements. We enrolled all the patients (16) affected on vascular malformations everywhere in the body, treated from January to August 2012. We obtained excellent results in 6 patients (37.5%) with mean mass reduction of 85%, good in 9 patients (56%) with mean mass reduction of 65% and unsatisfactory in 1 patient (6%). In pediatric patients, low-flow vascular malformations resistant to progressive sclerotherapy or in critical anatomical sites, benefit of echo guided interstitial 980-nm diode laser.

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A Step-by-step Sonographic Approach to Vascular Anomalies in the Pediatric Population: A Pictorial Essay

Indian Journal of Radiology and Imaging ◽

10.1055/s-0041-1729486 ◽

2021 ◽

Author(s):

Anushka Mittal ◽

Rama Anand ◽

Richa Gauba ◽

Subhasis Roy Choudhury ◽

Pooja Abbey

Keyword(s):

Vascular Malformations ◽

Pediatric Population ◽

Vascular Supply ◽

Clinical Findings ◽

Vascular Anomalies ◽

Doppler Imaging ◽

Low Flow ◽

Vascular Tumors ◽

Pictorial Essay ◽

Soft Tissue Masses

AbstractVascular anomalies are a common cause of soft-tissue masses in children and often referred for ultrasonographic (USG) evaluation. They are broadly classified as vascular tumors (hemangiomas, hemangioendotheliomas, and angiosarcomas) or vascular malformations (venous malformations, lymphatic malformations, and arteriovenous malformations). Findings on USG and Doppler imaging can be used to categorize vascular anomalies into high- or low-flow lesions, which forms the basis for further workup, diagnosis, and management. On careful evaluation of various sonographic features, in conjunction with clinical findings, an accurate clinicoradiological diagnosis can be made in most cases. Further imaging with magnetic resonance (MR) imaging or computed tomography (CT) helps in delineation of lesion extent, whereas MR or CT angiography is useful to map the vascular supply of high-flow lesions. We have illustrated and discussed a step-by-step approach to diagnose vascular anomalies using ultrasound and Doppler imaging.

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A Study of Iron Status in Pediatric Patients with large complex Vascular Malfomations

QJM ◽

10.1093/qjmed/hcab113.007 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohamed Abdel-Mohsen Ellaboudy ◽

Iman A Ragab ◽

Amr Abdel Hamid Abo-Zeid ◽

Heba G.A Ali ◽

AliaaMourad Ahmed

Keyword(s):

Iron Deficiency ◽

Pediatric Patients ◽

Vascular Malformations ◽

Iron Status ◽

Vascular Anomalies ◽

Control Group ◽

P Value ◽

Normal Children ◽

Large Complex ◽

Significant Difference

Abstract Background Complex vascular malformations involving the gastrointestinal tract (GIT) are expected to develop iron deficiency.However, the haemoglobin and iron status of vascular anomalies unrelated to GIT were not addressed. Our aim was to study the frequency of anemia and iron status among pediatric patients with large/complex vascular malformations without evident bleeding and to correlate the findings with the type, site, severity and extension of vascular malformationand treatment with sirolimus. Patients and method A case control study of participants with large complex vascular malformationregistered at Ain Shams University vascular anomalies clinic during the period from June 2019 to June 2020.They were compared to 20 age, sex and socioeconomic standard matched healthy controls. Clinical and laboratory studies for iron status were performed. Results fifty percentof patients were anemic versus 65% of the control group (p value = 0.33).As regards iron status of patients, 35% has combined iron deficiency versus 40% of controls, 20% has functional iron deficiency versus 20% of controls, 5% has absolute iron deficiency versus 10% of controls (p value = 0.90). There was no significant difference between patients receivingsirolimus and who are not as regards anemia and iron status (p value = 0.36, 0.84, respectively). Conclusion The frequency of anemia and it s iron related classification are comparable in children with large vascular malformations with no bleeding manifestations to normal children.

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Vascular Birthmarks as a Clue for Complex and Syndromic Vascular Anomalies

Frontiers in Pediatrics ◽

10.3389/fped.2021.730393 ◽

2021 ◽

Vol 9 ◽

Author(s):

Andrea Diociaiuti ◽

Guglielmo Paolantonio ◽

Mario Zama ◽

Rita Alaggio ◽

Claudia Carnevale ◽

...

Keyword(s):

Vascular Malformation ◽

Early Recognition ◽

Vascular Malformations ◽

Clinical Signs ◽

Vascular Anomalies ◽

Vascular Lesions ◽

Vascular Tumors ◽

Capillary Malformation ◽

Wide Range ◽

Vascular Birthmarks

Vascular birthmarks are common in neonates (prevalence: 20–30%) and mostly incidental findings sometimes with spontaneous regression (salmon patch and nevus simplex). Capillary malformations are found in about 1% and infantile hemangiomas are found in 4% of mature newborns. Vascular malformations are classified according to their most prominent vessel type. The term “capillary malformation” (port wine stain) includes a wide range of vascular lesions with different characteristics; they may be isolated or part of specific syndromic conditions. Part of the infantile hemangiomas and of the vascular malformations may require treatment for functional or cosmetic reasons, and in rare cases, investigations are also necessary as they represent a clue for the diagnosis of complex vascular malformation or tumors associated with extracutaneous abnormalities. Complex vascular malformations are mostly mosaicism due to early somatic mutations. Genetic advances have led to identify the main pathogenic pathways involved in this disease group. Diffuse capillary malformation with overgrowth, Klippel–Trenaunay syndrome, CLAPO syndrome, CLOVES syndrome, and megalencephaly-capillary malformation belong to the PIK3CA-related overgrowth. Capillary malformation–arteriovenous malformation underlies a fast-flow vascular malformation, sometimes manifesting as Parkes–Weber syndrome. Recognition of these different types of capillary vascular stains is sometimes difficult; however, associated findings may orient the clinicians while genetic testing may confirm the diagnosis. Lymphatic malformation frequently manifests as large masses that compress and/or infiltrate the surrounding tissues, representing a neonatal emergency when airways are involved. Infantile hemangiomas may cause functional and/or permanent esthetical damage, depending on their localization (such as periorbital area, lip, nose); large (more than 5 cm) infantile hemangiomas with a segmental distribution can be associated with obstruction or malformations of the underneath organs with complications: PHACE syndrome, LUMBAR/SACRAL syndrome, and beard infantile hemangioma. In our review, we discuss controversies regarding the international classification and emerging concepts in the field of vascular anomalies. Finally, we discuss potential developments of new, non-invasive diagnostic techniques and repurposing of target therapies from oncology. Complex and/or life-threatening vascular tumors and malformations are extremely rare events and they represent a considerable therapeutic challenge. Early recognition of clinical signs suggestive for a specific disease may improve therapeutic outcomes and avoid severe complications.

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Multiple Venous Malformations with Phleboliths: Radiological-Pathological Correlation

Journal of Clinical Imaging Science ◽

10.4103/2156-7514.124058 ◽

2013 ◽

Vol 3 ◽

pp. 13 ◽

Cited By ~ 3

Author(s):

Venkateswara Rao Chava ◽

Ashwini Naveen Shankar ◽

Naveen Shankar Vemanna ◽

Sudheer Kumar Cholleti

Keyword(s):

Head And Neck ◽

Clinical Symptoms ◽

Vascular Malformations ◽

High Flow ◽

The Body ◽

Low Flow ◽

Venous Malformations ◽

Congenital Lesions ◽

The Face ◽

Histopathologic Findings

Vascular malformations are congenital lesions that are present at birth and do not regress. However, they often present later in life. They are subdivided into two categories: (1) slow- or low-flow and (2) fast- or high-flow malformations. Low-flow malformations contain combinations of capillary, venous, and lymphatic components. Venous malformations can occur anywhere in the body, but are most frequently seen in the head and neck (40%). These lesions present in a variety of ways, from a vague blue patch to a soft blue mass, which may be single isolated or may occur in multiple areas. Treatment depends on the type of lesion, the location, degree of involvement, and the clinical symptoms. Here we are report the imaging and histopathologic findings in a patient with multiple venous malformations affecting the left side of the face and trunk.

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High-Flow Vascular Malformations in Children

Seminars in Neurology ◽

10.1055/s-0040-1708869 ◽

2020 ◽

Vol 40 (03) ◽

pp. 303-314

Author(s):

Ramin A. Morshed ◽

Ethan A. Winkler ◽

Helen Kim ◽

Steve Braunstein ◽

Daniel L. Cooke ◽

...

Keyword(s):

Vascular Malformations ◽

Treatment Strategies ◽

High Flow ◽

Vascular Anomalies ◽

Low Flow ◽

Cavernous Malformations ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas ◽

Clinical Consequences ◽

The Central Nervous System

AbstractChildren can have a variety of intracranial vascular anomalies ranging from small and incidental with no clinical consequences to complex lesions that can cause substantial neurologic deficits, heart failure, or profoundly affect development. In contrast to high-flow lesions with direct arterial-to-venous shunts, low-flow lesions such as cavernous malformations are associated with a lower likelihood of substantial hemorrhage, and a more benign course. Management of vascular anomalies in children has to incorporate an understanding of how treatment strategies may affect the normal development of the central nervous system. In this review, we discuss the etiologies, epidemiology, natural history, and genetic risk factors of three high-flow vascular malformations seen in children: brain arteriovenous malformations, intracranial dural arteriovenous fistulas, and vein of Galen malformations.

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Endoscopic Endonasal Excision of an Optic Pathway Cavernous Malformation: Technical Case Report

Operative Neurosurgery ◽

10.1093/ons/opab094 ◽

2021 ◽

Author(s):

Biren Khimji Patel ◽

A Jaypalsinh Gohil ◽

Prakash Nair ◽

Easwer H.V. ◽

Deepti A.N.

Keyword(s):

Clinical Presentation ◽

Cavernous Malformation ◽

Vascular Malformations ◽

Low Flow ◽

Visual Field Defects ◽

Optic Pathway ◽

Endoscopic Endonasal ◽

Cavernous Malformations ◽

Magnetic Resonance Imaging Mri ◽

Bitemporal Hemianopia

Abstract BACKGROUND AND IMPORTANCE Cavernous malformations (CMs) are angiographically occult low-flow vascular malformations that infrequently involve the optic pathway and the hypothalamus (OPH). CLINICAL PRESENTATION A 23-yr-old male presented with bitemporal hemianopia due to chaismal apoplexy. Imaging revealed a CM involving the OPH. The CM was resected by an extended endonasal approach. The patient had improvement in his visual field defects, and postoperative magnetic resonance imaging (MRI) revealed a gross total resection of the CM. CONCLUSION This case demonstrates the surgical technique of endoscopic endonasal resection of a CM involving the optic pathway.

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Congenital Arteriovenous Malformation of Lip - A Case Report

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/482 ◽

2021 ◽

Vol 10 (30) ◽

pp. 2354-2357

Author(s):

Rajasbala Pradeep Dhande ◽

Megha Manoj ◽

Roohi Gupta ◽

Prerna Patwa ◽

Prasanthi Ghanta

Keyword(s):

Arteriovenous Malformation ◽

Vascular Malformations ◽

Venous Malformation ◽

The Body ◽

Vascular Anomalies ◽

Surrounding Tissue ◽

Signal Process ◽

Vascular Neoplasms ◽

Congenital Arteriovenous Malformation ◽

Av Malformation

Vascular anomalies are a heterogeneous group of lesions involving vascular channels including the lymphatics. They encompass a wide variety of lesions from simple capillary haemangiomas to angiosarcomas. These lesions most commonly occur as a result of developmental error during embryogenesis due to defective signal process.1 Most of these lesions occur sporadically while a few may be inherited or acquired. Inherited lesions tend to be small and multi-centric which gradually increase its size with age.2 The International Society for the Study of Vascular Anomalies has broadly classified vascular anomalies into 2 groups: 1) Vascular neoplasms and 2) Vascular malformations.3 Vascular malformations are a relatively rare group of lesions involving the endothelium and surrounding tissue of arteries and veins resulting in an abnormal arteriovenous shunting. They are categorised into 4 types: 1) Venous malformation, 2) Capillary malformation, 3) Arteriovenous malformation and 4) Lymphatic malformation. They can occur anywhere in the body from head to toe, but they are most commonly seen in the brain. The most common extra-cranial site for AV malformations is the head and neck and other common sites include limbs, trunk and viscera.4 Here, we a present a rare case of congenital AV malformation of lip in a 49-year-old male.

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Peripheral Malformations

Interventional Radiology ◽

10.1093/med/9780190276249.003.0024 ◽

2018 ◽

pp. 301-314

Author(s):

David T. Jacobs ◽

David C. Moe ◽

Patricia E. Burrows

Keyword(s):

Vascular Malformations ◽

Signs And Symptoms ◽

Vascular Lesion ◽

Vascular Anomalies ◽

Low Flow ◽

Vascular Tumors ◽

Extensive Discussion ◽

Clinical Appearance ◽

Angiogenic Proteins ◽

Klippel Trenaunay Syndrome

This chapter, on peripheral malformations, provides an overview of vascular anomalies encountered in the practice of interventional radiology (IR), with a brief discussion of vascular tumors followed by vascular malformations. These include low-flow lesions, lymphatic malformations (LMs) and venous malformations (VMs); high-flow lesions, arteriovenous malformations (AVMs) and arteriovenous fistula (AVF); and Klippel-Trenaunay syndrome (KTS), the combined vascular lesion syndrome of the lower extremity. The natural history, signs and symptoms, clinical appearance, imaging appearance, and treatment of these lesions will be discussed, and illustrative photographs and radiologic studies of typical cases are provided. In recent years, much has been learned about the genetic basis of vascular malformations, which are caused by somatic mutations in a number of angiogenic proteins. Pharmacological treatment, based on these molecular findings, is available for some lesions. Extensive discussion on the biological basis for vascular anomalies is beyond the scope of this chapter.

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A Diagnostic Program of Vascular Tumor and Vascular Malformations in Children According to Modern Classification

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2017.47 ◽

2017 ◽

Vol 60 (1) ◽

pp. 19-26

Author(s):

Iryna Benzar

Keyword(s):

Soft Tissues ◽

Vascular Malformations ◽

Screening Method ◽

Clinical Manifestations ◽

Diagnostic Procedures ◽

Vascular Tumor ◽

Vascular Anomalies ◽

Low Flow ◽

Vascular Tumors ◽

Patients Âgés

The aim of the study was to analyze the cohort of inpatient children with vascular anomalies according to the globally accepted classification introduced by the ISSVA. Methods: The study included 205 inpatient children within the time period of the years 2010–2015. Types of vascular anomalies (VAs), age of patients, diagnostic procedures, and anatomical localization of VAs were analyzed. Results: 65 patients of first year of life had vascular tumors, with prevalence of infantile hemangiomas (IHs) in 57 (87.7%) patients. 45 children had IHs localized within soft tissues, whereas 7 patients suffered from IHs of the liver, and 5 children from IHs of the respiratory tract. Most patients with soft tissue IHs were diagnosed only with ultrasound; СT or MRI diagnostics were performed on 5 (8.8%) patients, and biopsy was carried out in 2 (4.4%) children. Vascular malformations (VM) were diagnosed in 140 (68.3%) patients. Ultrasound investigation (US) was the screening method. MRI was performed to confirm the diagnosis of low-flow VM, whereas for high-flow VM CT angiography and selective angiography were useful. Venous malformations were diagnosed in 17 (12.1%) patients, and 112 (80.0%) had cystic LM, among them children under the age of 2 years prevailed. Arteriovenous malformations were diagnosed in 5 (3.8%) patients, ages 2–14 years. Conclusions: Clinical manifestations of vascular anomalies have clear age features. Among hospitalized children vascular tumors add up to 31.7% and VM – up to 68.3%.

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Creating the Wind

Latin American and Latinx Visual Culture ◽

10.1525/lavc.2020.2.4.14 ◽

2020 ◽

Vol 2 (4) ◽

pp. 14-31

Author(s):

Élodie Dupey García

Keyword(s):

Indigenous Communities ◽

The Body ◽

Historical Sources ◽

Natural Behavior ◽

Sensory Experiences ◽

Identity And Agency ◽

Wide Range ◽

Late Postclassic ◽

Comparative Examination ◽

Meteorological Phenomenon

This article explores how the Nahua of late Postclassic Mesoamerica (1200–1521 CE) created living and material embodiments of their wind god constructed on the basis of sensory experiences that shaped their conception of this divinized meteorological phenomenon. In this process, they employed chromatic and design devices, based on a wide range of natural elements, to add several layers of meaning to the human, painted, and sculpted supports dressed in the god’s insignia. Through a comparative examination of pre-Columbian visual production—especially codices and sculptures—historical sources mainly written in Nahuatl during the viceregal period, and ethnographic data on indigenous communities in modern Mexico, my analysis targets the body paint and shell jewelry of the anthropomorphic “images” of the wind god, along with the Feathered Serpent and the monkey-inspired embodiments of the deity. This study identifies the centrality of other human senses beyond sight in the conception of the wind god and the making of its earthly manifestations. Constructing these deity “images” was tantamount to creating the wind because they were intended to be visual replicas of the wind’s natural behavior. At the same time, they referred to the identity and agency of the wind god in myths and rituals.

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