Vascular Anomalies: Hemangiomas and Beyond—Part 1, Fast-Flow Lesions

Abstract

Nonuniformity of terminology across the medical literature hampers understanding of the vascular anomalies. A familiarity with the classification and biology on which this terminology is based is essential for accurate and precise diagnosis.

Imaging evaluation of fetal vascular anomalies

“…We also noted thickening and infiltration of the subcutaneous fat in the proximal portion of the lesion. This has been described as a highly characteristic feature of kaposiform hemangioendothelioma on postnatal MRI and might also have guided our diagnosis [6,28].…”

“…An arteriovenous fistula or arteriovenous malformation shows high-flow vessels on color Doppler US and pulsatile veins and high diastolic arterial waveforms on pulsed Doppler US and usually lacks an associated soft-tissue mass. This imaging pattern did not fit with any of the vascular tumors in our cohort and thus these high-flow vascular malformations were not considered in the differential diagnosis [6]. In case 11, the capillary-lymphatic-arteriovenous malformation with overgrowth (also known as Parkes-Weber syndrome), the diagnosis was supported by the presence of hypervascularity of the involved tissues, signs of arteriovenous connections throughout the lesion on pulsed Doppler US and associated limb hypertrophy [31].…”

“…This group of so-called overgrowth disorders includes lesions composed of high-flow or low-flow components, or a combination of both. Overgrowth can start in utero with low-flow combined lesions such as capillarylymphatic-venous malformations or with high-flow combined malformations such as capillary-lymphatic-arteriovenous or capillary-venous-arteriovenous malformations [6][7][8].…”

High-pitch spiral CT with 3D reformation: an alternative choice for imaging vascular anomalies with affluent blood flow in the head and neck of infants and children

“…13 The diagnostic criteria of VAs were as follows. 6,8,[14][15][16] (1) For lesions with predominantly straight arterial feeders, a soft-tissue component and serpiginous veins, haemangiomas were the first diagnosis considered. (2) Lesions with dilated and tortuous feeding arteries, early enhancing draining veins during the arterial phase and a tangle of vessels with no prominent soft-tissue component were initially considered to be AVMs.…”

“…There has been great progress in VA management in the past decade. 1,2 Advanced therapeutic methods, such as scelerotherapy for venous malformation (VM), 3,4 propranolol/bleomycin treatment for infantile haemangioma, 5,6 as well as the importance of eliminating the "nidus" in arteriovenous malformation (AVM), 7 obviously improve the cure rate of VAs.…”