Soft-Tissue Hemangioma and Vascular Malformation : Ultrasonographic Differentiation Department of Diagnostic Radiology, College of Medicine, Dong-A University HS Shin, JY Oh, SS Choi, BH Park, KN Lee, KJ Nam, YI Lee

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Soft-Tissue Hemangioma and Vascular
Malformation Ultrasonographic
DifferentiationDepartment of Diagnostic
Radiology, College of Medicine, Dong-A
UniversityHS Shin, JY Oh, SS Choi, BH Park, KN
Lee, KJ Nam, YI Lee
Purpose
To differentiate the Ultrasonographic findings
of Hemangioma and Vascular Malformation arising
from soft tissue
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Materials and Methods
Fig.3. Arteriovenous Malformation A. Photograph
of a seven month-old patient with about 4x2cm
sized, erythematous nodule and irrgular surface
with purplish red discoloration of the skin and
located below the left auricle. B. Longitudinal
color Doppler US image reveals numerous vascular
structures in the mass.( high vessel density) C.
Color Doppler US image with spectral analysis of
sample volume reveals arterial wave form within a
vessel.
We reviewed the US findings of soft tissue
vascular mass in thirty six patients( MF
1917) ranging in age from three months to 13
years (mean 36 months). Among them, 14 cases were
histologically confirmed by operation. The 22
cases were retrospectively diagnosed by clinical
history, physical examination and involution of
lesion during follow-up period. We analyzed
presence of solid tissue, abnormal artery and
vein, echogenecity, vessel density. The resistive
index and peak flow velocity were evaluated in
mass, feeding arteries and draining veins.
Results
There were 27 hemangioma and nine vascular
malformation (three arteriovenous malformation,
three lymphangioma, three venous malformation).
The significant differences were noted between
hemangioma (24 of 27 cases, 88) and vascular
malformation (one of nine cases, 11) with
respect to the presence of a solid tissue mass(plt
.001). The vessel density of arteriovenous
malformation was greater compared with hemangioma
and other vascular malformation such as
lymphangioma or venous malformation. The
lymphangioma was easily distinguished from
hemangioma and other vascular malformation by the
poor vascularities, multiseptated cysts in mass.
No differences in echogenecity, vessel density,
presence of abnormal artery and vein, resistive
index and peak flow velocity of vessles were
detected between hemangioma and vascular
malformation.
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Fig.4. Lymphatic Malformation A. T1 weighted
coronal image demonstrates multi-septated cystic
mass in the subcutaneous portion of buttock and
thigh. B. Transverse US image demonstrates
multiple collection of subcutaneous cysts
septated by echogenic stroma. C. Color Dopple US
reveals a few vesseles along echogenic septa.
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B
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B
Fig.5. Venous Malformation A. T1 weighted
Gd-enhanced fat suppresed coronal image
demonstrates multiple, tortous enhancing vascular
structures in the subcutaneous portion of the
right thigh. B. Color Doppler US image reveals
several venous structure in the mass on
compression view. C. Color Doppler US image with
spectral analysis of sample volume reveals venous
wave form within a vessel on compression view.
Fig.1. Strawberry Hemangioma A. Photograph of a
nine month-old patient with about 2x2cm sized,
erythematous nodule and purplish red
discoloration of the skin and located in the left
infraorbital area. B. Transverse color Doppler US
image reveals multiple vessles coursing through
the mass ( moderate vessel density) C.
Longitudunal color Doppler US image with spectral
analysis of sample volume reveals an arterial
wave form within a vessel.
Conclusion
The hemangioma and vascular malformation are
different in treatment and subsequent prognosis.
The ultrasonography can be used distinguish
hemangioma from vascular malformation.
Reference
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1. Harriet J, Patrica E, Harry P.W, David, John
B. Soft-Tissue Vascular Anomalies of US for
Diagnosis. Radiology 2000 214747-754 2. Dubois
J, Patriquin HB, Garel L, et al. Softtissue
hemangiom as in infants and children diagnosis
using Doppler sonography. AJR 1998
171247-252 3. Bulas DI, Johnson D, Allen JF,
Kapur S. Fetal hemangioma sonographic and color
flow Doppler findings. J Ultrasound Med 1992
11499-501. 4. Cohen JM, Weinreb JC, Redman HC.
Arteriovenous malformations of the extremities
MR imaging. Radiology 1986 158475-479
Fig.2. Cavernous Hemangioma A. Photograph of a
five year-old patient with about 1.2x1.2cm sized,
soft-fluctuating nodule and located in the
left-sided nose. B. Transverse color Doppler US
image of the left-sided nose reveals low-echoic
mass containing several vessles.( low vessel
density) C. Color Doppler US image with spectral
analysis of sample volume reveals an arterial
wave form within a vessel.