scholarly journals Multimodality imaging and interventional management of a complex congenital vascular malformation

2010 ◽  
Vol 14 (2) ◽  
pp. 32
Author(s):  
Aadil Ahmed

Hepatic vascular lesions are not an uncommon finding in children, and represent the most common benign liver tumours to present in infancy. We present a case of a complex vascular malformation with an intrahepatic component suggestive of a venous/arteriovenous malformation as well as a large extrahepatic lesion. The extrahepatic mass was present in both sub- and supra-diaphragmatic locations ,with features of a congenital haemangioma. In view of the clinical presentation and different imaging appearances, this case was felt to be interesting in its radiological workup, management and eventual unusual pathology.

2008 ◽  
Vol 108 (6) ◽  
pp. 1142-1147 ◽  
Author(s):  
So-Hyang Im ◽  
Moon Hee Han ◽  
Bae Ju Kwon ◽  
Jung Yong Ahn ◽  
Cheolkyu Jung ◽  
...  

Object Considerable confusion exists in the literature regarding the classification of cerebrovascular malformations and their clinical significance. One example is provided by the atypical developmental venous anomaly (DVA) with arteriovenous shunt, because it remains controversial whether these lesions should be classified as DVAs or as atypical cases of other subtypes of cerebrovascular malformations. The purpose of this study was to clarify the classification of these challenging vascular lesions in an effort to suggest an appropriate diagnosis and management strategy. Methods The authors present a series of 15 patients with intracranial vascular malformations that were angiographically classified as atypical DVAs with arteriovenous shunts. This type of vascular malformation shows a fine arterial blush without a distinct nidus and early filling of dilated medullary veins that drain these arterial components during the arterial phase on angiography. Those prominent medullary veins converge toward an enlarged main draining vein, which together form the caput medusae appearance of a typical DVA. Results Based on clinical, angiographic, surgical, and histological findings, the authors propose classifying these vascular malformations as a subtype of an arteriovenous malformation (AVM), rather than as a variant of DVA or as a combined vascular malformation. Conclusions Correct recognition of this AVM subtype is required for its proper management, and its clinical behavior appears to follow that of a typical AVM. Gamma Knife radiosurgery appears to be a good alternative to resection, although long-term follow-up results require verification.


2007 ◽  
Vol 22 (6) ◽  
pp. 253-257 ◽  
Author(s):  
B B Lee ◽  
J Laredo ◽  
S J Lee ◽  
S H Huh ◽  
J H Joe ◽  
...  

Venous malformation (VM) is the most common congenital vascular malformation (CVM), which usually presents as a single lesion in the majority of cases. It also presents as a mixed lesion combined with other CVMs (e.g. lymphatic malformation and arteriovenous malformation [AVM]). Therefore, the diagnosis of VM should include an appropriate work-up, to not only confirm and characterize the VM as either extratruncular or truncular but also to diagnose or exclude the presence of other CVMs. The diagnosis of VM can be made safely using non-invasive to minimally invasive studies, which can also distinguish VM from infantile haemangioma. Invasive studies, such as venography and arteriography, are generally reserved for therapeutic planning and diagnosis of more virulent CVMs (e.g. AVM). The work-up of VM should include a complete assessment of the extent and severity of the primary VM lesion. In addition, its embryologic origin, as well as its haemodynamic characteristics and secondary effects should also be determined.


1998 ◽  
Vol 56 (1) ◽  
pp. 129-132 ◽  
Author(s):  
ANTONIO CARLOS DE PÁDUA MILAGRES ◽  
FLÁVIO ALÓE ◽  
JOÃO CARLOS PAPATERRA LIMONGI

The authors report the case of a 50 year-old hypertensive male patient with a pontine hematoma. The clinical presentation was characterized by pure pyramidal deficit signs (no other signs or symptoms were present). A pure hemiplegia syndrome, although common in supratentorial lesions, is considered to be a rare event in pontine vascular lesions. The pathophysiologic mechanisms of these neurological findings are unclear. The exclusive involvement of the pyramidal tract in this case is likely due to a variation in the vascular anatomy of the pons but, in some cases, a vascular malformation may be the cause.


2015 ◽  
Vol 68 (1) ◽  
pp. 3-7 ◽  
Author(s):  
Péter Kupcsulik ◽  
Oszkár Hahn ◽  
Attila Szíjártó ◽  
Attila Zsirka ◽  
Tamás Winternitz ◽  
...  

Munkahelyünkön 2004–2014 között 273 elektív műtét történt benignus májelváltozás miatt. 83 esetben laparoszkópos (LAP) beavatkozásra került sor: cystafenestratio 52, májresectio 31 esetben történt. A LAP resectiókat hasonló demográfiai és klinikai jellemzőkkel bíró betegek nyitott műtéteivel összehasonlítva megállapítható, hogy a műtéti idő a LAP csoportban (113,7 perc) szignifikánsan hosszabb volt, mint a nyitott műtéteknél (89,5 perc), a kórházi ápolási idő viszont rövidebb (5,8 vs 9,1 nap). Posztoperatív szövődmény a LAP csoportban nem volt, nyitott műtétek után két sebgennyedés, egy UH-vezérelt drainezést igénylő epegyülem fordult elő. A nyitott csoportban 4, a LAP csoportban 3 beteg igényelt transzfúziót. Műtéti halálozás nem volt, reoperációra nem került sor. A közleményben részletezett műtéti technika biztonságos resectiót tesz lehetővé a máj nehezen hozzáférhető, 7–8. szegmentuma területén is. Az eredmények alapján a LAP májresectio megfelelő preoperatív vizsgálatok birtokában választható módszer májdaganatok sebészi kezelésére.


2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R E Fraser ◽  
G R Layton ◽  
L L Kuan ◽  
A R Dennison

Abstract Background Cavernous hepatic haemangiomas are benign liver tumours and although common when small, giant haemangiomas (usually accepted as being greater than 10cm) are infrequent. Treatment is indicated in patients who are symptomatic or if diagnosis is unclear, although with giant haemangiomas, many support expectant management of asymptomatic lesions due to the risk of major complications. Traditionally hepatic resection has been the primary treatment option for these lesions, but a variety of other techniques, including enucleation, have been described as safe and effective alternatives. There remains equipoise in respect of the best management of giant haemangiomas above 10cm. Cases of such size are rare and so there is a paucity of data available. Case presentation We present a case of a 65-year-old male who underwent successful anatomical liver resection for a 5kg giant cavernous haemangioma of 26cm diameter following its incidental identification during an ultrasound scan. We also discuss and compare the role of resection and enucleation for the treatment of haemangiomata greater than 20cm in diameter. Conclusions This case demonstrates successful resection of an unusually giant haemangioma which, in contrast to the majority of literature, provides a valuable addition to the limited evidence base for management of this condition by anatomical resection.


2020 ◽  
Author(s):  
Katharina Keuenhof ◽  
Patrick Heimel ◽  
L.M. Zopf ◽  
Martin Raigel ◽  
Anna Turyanskaya ◽  
...  

Author(s):  
Nelson Ugwu ◽  
Lihi Atzmony ◽  
Katharine Ellis ◽  
Gauri Panse ◽  
Dhanpat Jain ◽  
...  

2007 ◽  
Vol 89 (1) ◽  
pp. 12-21 ◽  
Author(s):  
Mark D Stringer

In recent years, considerable progress has been made in the treatment of children with hepatoblastoma largely due to effective pre-operative chemotherapy. Total hepatectomy and liver transplantation has emerged as an effective treatment for the small proportion of children with unresectable hepatoblastoma limited to the liver. A 5-year survival of 70% can be achieved in such cases. In contrast, the results of liver transplantation in children with hepatocellular cancer remain poor because these tumours are usually advanced with evidence of major vascular invasion and/or extrahepatic spread at the time of presentation. An exception is those children in whom the hepatocellular carcinoma is detected during surveillance of chronic liver disease – they typically have smaller tumours and frequently have a good prognosis after liver transplantation. The role of liver transplantation in children with other primary hepatic malignancies remains uncertain because experience is very limited. Liver transplantation is rarely needed in the management of children with benign liver tumours but, if other treatments have failed, it can be a life-saving intervention.


Author(s):  
Virender Malik ◽  
Harshith Kramadhari ◽  
Jawahar Rathod ◽  
Yadav W. Munde ◽  
Uday Bhanu Kovilapu

AbstractThe peripheral high-flow vascular malformation (HFVM) comprises arteriovenous malformation (AVM) and fistula (AVF), shows varied clinical presentation (ranging from subtle skin lesion to life-threatening congestive heart failure), and frequently poses diagnostic and therapeutic challenges. Importance of assigning a specific diagnosis to the vascular malformation cannot be overstated, as the treatment strategy is based on the type of vascular anomaly. Although the International Society for the Study of Vascular Anomalies (ISSVA) classification system is the most commonly accepted system for classifying congenital vascular anomalies in clinical practice, the Cho–Do et al classification is of utmost help in guiding optimal mode of treatment in peripheral AVM. Although transarterial approach remains the most commonly employed route for peripheral AVM embolization, the role of transvenous and direct percutaneous approach is ever increasing and the final decision on the approach depends on angioarchitecture of the AVM. In this article, we review various commonly employed classification systems for congenital vascular anomalies, and describe clinical features, imaging and treatment strategies for peripheral arteriovenous malformation (PAVM).


2010 ◽  
Vol 92 (5) ◽  
pp. e18-e20 ◽  
Author(s):  
N Marsden ◽  
K Shokrollahi ◽  
K Maw ◽  
A Sierakowski ◽  
FA Bhat ◽  
...  

The association between congenital vascular malformations and altered bone growth, the so-called vascular bone syndrome, is well documented. Various eponymous syndromes each with their individual traits, such as Klippel–Trenaunay, Parkes–Weber and Servelle–Martorell syndrome have been described, along with variations. We report on a previously undescribed case of congenital vascular malformation associated with multiple skeletal abnormalities affecting the skull, vertebrae and right upper limb, and discuss the literature.


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