PURPOSE: To characterize the MR findings for a differential diagnosis and to make a plan for treatment by interventional technique of the vascular masses with/without hypertrophic feeding vessels of the head and neck. SUBJCETS AND METHODS: Seven patients with vascular masses of the head and neck proved by pathology, angiography, clinical findings were included. Vascular masses included 4 venous malformations, a capillary hemangioma, and a hemangiopericytoma, a hemangioma combined with arteriovenous malformation. 7 patients had MR studies with 1.0T and 1.5T using routine TI-, T2- weighted spin echo sequences, and contrast enhancement. 4 MR angiography, 3 inversion recovery, and 6 contrast angiography were studied from 7 patients RESULTS: All vascular masses demonstrated higher than muscle signal intensity on Tl-weighted images, bright signal intensity on T2-weighted images, and prominent enhancement, except AV hemangioma combined with prominent arteriovenous malformation on postcontrast scan. Three hemangiomas demonstrated distinct serpiginous signal voids. Venous malformations demonstrated venous lakes seen as homogenous regions of high signal intensity and phleboliths seen as low signal foci on images. Inversion recovery was the best pulse sequence for evaluation of the extent of lesion. CONCLUSION: MR findings of the vascular masses of the head and neck are useful in delineating the extent of the disease, differentiating venous malformation or cavernous hemangioma from other hemangiomatous lesions including hypertrophic feeding vessels, and making a plan for treatment by interventional technique also.
Angiography ; Arteriovenous Malformations ; Diagnosis, Differential* ; Head* ; Hemangioma ; Hemangioma, Capillary ; Hemangioma, Cavernous ; Hemangiopericytoma ; Humans ; Lakes ; Neck* ; Pathology

Dieulafoy's lesion is an uncommon cause of gastrointestinal bleeding. Hemorrhage occurs through mucosal erosion from an abnormally dilated submucosal artery. Although Dieulafoy's lesion is usually located in the stomach, it may occur anywhere in the gastrointestinal tract. We report here on a case of jejunal Dieulafoy's lesion presenting as a mass and short segment stricture on CT and enteroclysis.
Adult ; Arteriovenous Malformations/*pathology ; Diagnosis, Differential ; Gastrointestinal Hemorrhage/*pathology ; Humans ; Jejunal Diseases/*pathology ; Jejunum/blood supply/pathology ; Male

In order to obtain more accurate pathological diagosis of the angiographically occult vascular malformations(AOVM) of the brain in the future and to examine the clinical, and radiological characteristics and management outcome of the AOVM, the authors retrospectively reviewed the 30 cases of AOVM in which patients were treated at our instituition during the past 11-year period. The pathological specimens were reexamined, and the lesions were reclassified according to the strict histopathological criteria. The clinical characteristics, radiological features, the difference between the clinical and pathological diagnosis and the management results were studied. There were 15 males and 15 females. The mean age at the time of diagnosis was 31 years, ranging from 3 months to 74 years. The clinical diagnosis were arteriovenous malformation(AVM) in 18 cases, cavernous angioma in 11 and mixed lesion in 1. The pathologic diagnosis was AVM in 14 cases, cavernous angioma in 2, and unclassified lesion in 12. The common presenting symptoms were hemorrhage(53.3%), seizure(20.0%) and mass lesions(20.0%). Twenty four lesions were located at the supratentorial region, 4 at cerebellum and 2 at pons. Most of the lesions were revealed as high density masses with minimal or no contrast enhancement on CT and a core of mixed signal intensity with a peripheral low signal intensity rim on T2-weight MRI. Preoperative clinically significant recurrent hemorrhages were noted in 8 cases and one of them showed marked deterioration of the neurological functions a result of recurrent hemorrhage. Twenty-eight patients underwent surgery and all except one improved neurologically. Six patients initially presented with seizure showed improvement in seizure frequency after operation. One patient who had the lesion at the pons was managed by a radiosurgery and one patient who refused surgery was managed by a conservative method. The conservatively managed patient and another patient who was not found AVM at the hematoma cavity during initial operation rebled about 2 years later following diagnosis and surgery. Thse findings suggest that the complete microsurgical excision, which prevents rebleeding and suppresses seizure activity, represents the treatment of choice for patients with clinically symptomatic AOVM. Avoiding the injury of the vascular mass, obtaining sufficient biopsy specimen during surgery, together with careful histopathological observation of operative specimens through complete clinical-radiological-pathological context are necessary to obtain more accurate pathological diagnosis.
Arteriovenous Malformations ; Biopsy ; Brain ; Cerebellum ; Diagnosis ; Female ; Hemangioma, Cavernous ; Hematoma ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Male ; Pathology ; Pons ; Radiosurgery ; Retrospective Studies ; Seizures ; Vascular Malformations*

INTRODUCTIONHaemangiomas in children usually involute spontaneously and surgical treatment is exceptional. Vascular malformations do not regress spontaneously and resection may become necessary. We present a series of surgically treated face and neck vascular anomalies during a 9-year period, assessing the epidemiology, presenting signs and symptoms, diagnostic modalities, indications for surgery, treatment methods and clinical outcome post-treatment.

MATERIALS AND METHODSThe medical and pathological records of all patients with cervicofacial vascular anomalies treated surgically at our department from 1997 to 2005 were retrospectively reviewed in relation to current evidence.

RESULTSForty-one patients were identified. Of these, 9 patients had haemangiomas and the remaining 32 had a variety of vascular malformations. Cervicofacial vascular anomalies were most commonly located at the lip. Atypical looking vascular anomalies like masseteric intramuscular haemangiomas and parotid malformations were diagnostic problems. All 41 had surgical excision of their vascular anomalies for troubling symptoms, cosmesis or diagnostic purpose. For cervicofacial arteriovenous malformations, 28% were classified as Schobinger stage I, 50% stage II, and the remainder stage III. Combined embolisation-resection was used to treat 6 arteriovenous malformations (stage II to III) and of these, 3 required flap reconstruction.

CONCLUSIONSAccurate diagnosis distinguishing between cervicofacial haemangiomas and vascular malformations is key to best treatment. The diagnosis can usually be made by history and physical examination aided by early magnetic resonance imaging (MRI). Although cervicofacial haemangiomas can be managed conservatively or with medical therapy, surgery is indicated for preventing psychological distress and in cases of chronic aesthetic alteration resulting from partial regression. Aesthetic concerns and prevention of psychosocial distress point to early excision of venous malformation as the treatment of choice. Lymphatic malformations are best treated by excision. Outcome after excision of localised cervicofacial haemangiomas and low-flow vascular malformations is excellent. Large extensive low-flow malformations as well as those located at the lips may require multiple procedures including reconstruction; patients should be informed that the outcome is generally not as good. Combined embolisation-resection is definitive treatment for arteriovenous malformations and flap reconstruction may prevent their recurrence. Tissue expansion is a useful reconstructive tool after the excision of large vascular anomalies.

Adolescent ; Adult ; Arteriovenous Malformations ; diagnosis ; pathology ; surgery ; Child ; Child, Preschool ; Diagnosis, Differential ; Face ; blood supply ; Female ; Hemangioma ; diagnosis ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Neck ; blood supply ; Vascular Malformations ; diagnosis ; pathology ; surgery

A 51-year-old man visited the tertiary-care hospital with a 2-week history of dizziness and dyspnea on exertion. The initial hemoglobin level was 5.8 g/dL, without any history of hematochezia or melena. The esophagogastroduodenoscopy (EGD) was normal. During colonoscopic preparation, the patient experienced hematochezia and became hypotensive. On angiography, no extravasation of contrast media was observed. A CT scan with angiography showed a small high-density area in the jejunal lumen, suggesting extravasation of the contrast media. Capsule endoscopy was performed, and oozing bleeding was suspected in the proximal to mid jejunum. The patient was referred to our hospital. Repeated EGD and CT enterography did not reveal any significant bleeding. An antegrade double balloon endoscopy was performed, and an approximately 2-cm-sized submucosal tumor with ulceration and a non-bleeding exposed vessel was observed in the mid jejunum. The presumed diagnosis was jejunal gastrointestinal stromal tumor. The mass was surgically resected, and the final histopathological diagnosis was arteriovenous malformation.
Arteriovenous Malformations/*diagnosis/pathology ; Capsule Endoscopy ; Diagnosis, Differential ; Gastrointestinal Hemorrhage ; Gastrointestinal Stromal Tumors/diagnosis ; Humans ; Jejunum/*pathology ; Male ; Middle Aged ; Tomography, X-Ray Computed

Colonic arteriovenous malformation (AVM) is one of the causes of lower gastrointestinal bleeding. Unlike small vascular ectasia or angiodysplasia, colonic AVM tends to be solitary, large in size, and identified endoscopically as flat or elevated bright red lesion. Herein, we report a case of non-solitary and small cecal AVMs which were removed by endoscopic biopsy. A 66-yr-old woman was referred for routine gastrointestinal cancer screening. She was suffering from diabetes, hypertension, end-stage renal disease, and anemia of chronic disease. On colonoscopic finding, three semi-pedunculated polyps, less than 5 mm in size, were noticed near to the appendiceal orifice. Since the lesions revealed normal-looking epithelium with converging folds on the cecal base, lesions were diagnosed as inflammatory polyps on gross finding. Three biopsies were taken from each lesion. Bleeding from the biopsied site ceased spontaneously. Histopathologic evaluation demonstrated intramucosal hemorrhage and dilated submucosal vessels which were consistent with polypoid colonic AVMs.
Aged ; Arteriovenous Malformations/*diagnosis/pathology/surgery ; Biopsy ; Cecum/blood supply/pathology ; Colon/*blood supply/pathology ; Colonic Polyps/pathology/*surgery ; Colonoscopy ; Female ; Humans

We report on an exceptional vascular cause of gastrointestinal hemorrhage. A 30-yr-old man was admitted because of recurrent hematochezia. Colonoscopy showed circumferential, erythematous, and nodular vascular distensions with hematocystic spots in the terminal ileum resembling varicosis and subsequent computed tomography with 3-dimensional angiographic reconstruction revealed a vascular architecture around the terminal ileum. No other potential source of bleeding was identified. The patient was treated by ileocecectomy and the final diagnosis was of an arteriovenous malformation confined to the terminal ileum. He has been followedup without a further hemorrhagic episode.
Adult ; Arteriovenous Malformations/complications/*pathology ; Diagnosis, Differential ; Gastrointestinal Hemorrhage/etiology/*pathology ; Humans ; Ileum/*abnormalities ; Intestines/*blood supply ; Male ; Recurrence ; Varicose Veins/etiology/*pathology

Arteriovenous Malformations ; diagnosis ; etiology ; genetics ; Child ; Humans ; Immunoglobulin E ; blood ; Job Syndrome ; complications ; diagnosis ; genetics ; Lung ; diagnostic imaging ; pathology ; Male ; Mutation ; Radiography ; STAT3 Transcription Factor ; genetics

A 62-year-old woman was evaluated for tinnitis and headache. Magnetic resonance imaging and angiography revealed the coexistence of a tentorial tumor encroaching the junction of the right transverse-sigmoid sinuses, and dural arteriovenous fistulous malformation (AVFM) of the right transverse sinus. AVFM was not manipulated at all during the surgery. The pathology was fibroblastic meningioma. Postoperatively, the dural AVFM completely disappeared on follow-up angiography. The fistulas were occluded also after surgery, even though there was no manipulation of the AVFM. It is suggested that the right dominant transverse-sigmoid sinuses are partially occluded by tentorial meningioma, developing the dural arteriovenous fistula of the right transverse sinus. An acquired origin of the dural AVFM was suggested in this case.
Arteriovenous Malformations/diagnosis ; Arteriovenous Malformations/complications* ; Carotid Artery, External/pathology ; Carotid Artery, Internal/pathology ; Case Report ; Cerebral Angiography ; Dura Mater/pathology ; Female ; Human ; Jugular Veins/pathology ; Magnetic Resonance Imaging ; Meningeal Neoplasms/diagnosis ; Meningeal Neoplasms/complications* ; Meningioma/diagnosis ; Meningioma/complications* ; Middle Age

OBJECTIVETo investigate the clinicopathologic features of small intestinal hemangioma and vascular malformation.

METHODSA retrospective analysis was performed on 51 cases of hemangioma and vascular malformation involving the duodenum, jejunum and ileum in the past 30 years.

RESULTSThe patient's age ranged from 1.4 to 75.0 years, with an average/median age of 40 years for the 51 cases. The ratio of male and female was almost equal. In most cases, the lesions were located in the ileum (18 cases) and jejunum (16 cases) accounting for 66.7%. The predominant symptoms and signs were either intestinal hemorrhage or obstruction. Grossly, the lesions appeared as polyp-like, ulcerative, varices, solitary mass, diffuse infiltration or in an occult status. Histologically, arteriovenous hemangioma also called arteriovenous malformation was more common seen accounting for 86.3%. Other less common vascular lesions included cavernous hemangioma, capillary hemangioma, Rendu-Osler-Weber syndrome and Dieulafoy disease.

CONCLUSIONSHistologic classification and denomination for hemangioma and vascular malformation of small intestine are still controversial. It is very important to correlate clinical manifestations with arteriography findings in histologic diagnosis of hemanigoma and vascular malformation of the small intestine.

Adolescent ; Adult ; Aged ; Angiography ; Arteriovenous Malformations ; pathology ; Child ; Child, Preschool ; Diagnosis, Differential ; Female ; Hemangioma ; pathology ; Humans ; Infant ; Intestinal Neoplasms ; pathology ; Intestine, Small ; blood supply ; diagnostic imaging ; Male ; Middle Aged ; Retrospective Studies