9-year-old boy with a soft, bluish swelling in the left preauricular position, suspected venous malformation.
No increase of the swelling during physical exertion and Valsalva maneuvers, therefore glomuvenous malformation possible. Small scar from an unsuccessful previous operation.
Coronal, contrast-enhanced, dynamic MR angiography, MIP imaging 33 s after injection of the contrast medium. The contrast dynamic is in the venous phase, the venous blood vessels are fully contrasted. The venous malformation itself does not accumulate any contrast medium at this time.
Coronal, T1-weighted fat-suppressed MRI of the face after administration of contrast medium. The venous malformation enriches the contrast medium more clearly after 4 minutes, but relatively slowly and not yet completely at the time of imaging.
X-ray after direct injection of contrast medium into the venous malformation via 2 puncture needles. No outflow via any communication veins, good needle position for sclerotherapy. Now 2 ml of Aethoxysklerol 3% 1:4 admixed with air (foam sclerotherapy) are injected.
X-ray after injection of contrast medium into the venous malformation during the 2nd sclerotherapy 8 months later. Again no outflow via communicating veins is displayed. Good needle position for another foam sclerotherapy (3 ml Aethoxysklerol 3%, foamed 1:4 with air).
Sonography during sclerotherapy treatment. At the right side of the picture the still unfilled parts of the venous malformation, shown black as nearly echo-free vascular channels. On the left side lesion already filled by the sclerosing foam, echogenic with dorsal acoustic shadowing.
X-ray after injection of contrast medium into the venous malformation, for what is now the third sclerotherapy treatment after pain recurrence. Almost the entire remaining venous malformation is contrasted by contrast injection at the current needle position. Now 4.5 ml of Aethoxysklerol 3%, foamed 1 to 4 with air, is injected.
Venous malformations (VM) are particularly common in the facial area. Recurrent thrombophlebitis caused by coagulation processes within the blood-filled, dysplastic vascular spaces leads to pain. The esthetic appearance of the visibly discolored and swollen lesion in the face must be considered.
With a low-risk sclerosing treatment, here in the form of foam sclerotherapy, the venous malformation usually cannot be completely removed, but it can be greatly reduced. The swelling decreases. In addition, the patient becomes asymptomatic, as clots no longer form in the closed vascular spaces.
All images © Wohlgemuth