CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2021; 31(01): 157-171
DOI: 10.1055/s-0041-1729486
Pictorial Essay

A Step-by-Step Sonographic Approach to Vascular Anomalies in the Pediatric Population: A Pictorial Essay

Anushka Mittal
1   Department of Radio-Diagnosis, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
,
Rama Anand
1   Department of Radio-Diagnosis, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
,
Richa Gauba
1   Department of Radio-Diagnosis, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
,
Subhasis Roy Choudhury
2   Department of Pediatric Surgery, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
,
Pooja Abbey
1   Department of Radio-Diagnosis, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
› Institutsangaben

Abstract

Vascular anomalies are a common cause of soft-tissue masses in children and often referred for ultrasonographic (USG) evaluation. They are broadly classified as vascular tumors (hemangiomas, hemangioendotheliomas, and angiosarcomas) or vascular malformations (venous malformations, lymphatic malformations, and arteriovenous malformations). Findings on USG and Doppler imaging can be used to categorize vascular anomalies into high- or low-flow lesions, which forms the basis for further workup, diagnosis, and management. On careful evaluation of various sonographic features, in conjunction with clinical findings, an accurate clinicoradiological diagnosis can be made in most cases. Further imaging with magnetic resonance (MR) imaging or computed tomography (CT) helps in delineation of lesion extent, whereas MR or CT angiography is useful to map the vascular supply of high-flow lesions. We have illustrated and discussed a step-by-step approach to diagnose vascular anomalies using ultrasound and Doppler imaging.



Publikationsverlauf

Artikel online veröffentlicht:
13. Mai 2021

© 2021. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Fevurly RD, Fishman SJ. Vascular anomalies in pediatrics. Surg Clin North Am 2012; 92 (03) 769-800, x
  • 2 Marler JJ, Mulliken JB. Vascular anomalies: classification, diagnosis, and natural history. Facial Plast Surg Clin North Am 2001; 9 (04) 495-504
  • 3 International Society for the Study of Vascular anomalies. ISSVA classification of vascular anomalies. 2018. Available at: issva.org/classification. Accessed April 6, 2021
  • 4 Eifert S, Villavicencio JL, Kao TC, Taute BM, Rich NM. Prevalence of deep venous anomalies in congenital vascular malformations of venous predominance. J Vasc Surg 2000; 31 (03) 462-471
  • 5 Mulliken JB, Enjolras O. Congenital hemangiomas and infantile hemangioma: missing links. J Am Acad Dermatol 2004; 50 (06) 875-882
  • 6 Moore CW, Lowe LH. Hepatic tumors and tumor-like conditions. In: Slovis TL, ed. Caffey’s Pediatric Diagnostic Imaging. Philadelphia, PA: Mosby Elsevier 2008: 1929-1948
  • 7 Starkey E, Shahidullah H. Propranolol for infantile haemangiomas: a review. Arch Dis Child 2011; 96 (09) 890-893
  • 8 Krol A, MacArthur CJ. Congenital hemangiomas: rapidly involuting and noninvoluting congenital hemangiomas. Arch Facial Plast Surg 2005; 7 (05) 307-311
  • 9 Berenguer B, Mulliken JB, Enjolras O. et al. Rapidly involuting congenital hemangioma: clinical and histopathologic features. Pediatr Dev Pathol 2003; 6 (06) 495-510
  • 10 Burrows PE, Mulliken JB, Fellows KE, Strand RD. Childhood hemangiomas and vascular malformations: angiographic differentiation. AJR Am J Roentgenol 1983; 141 (03) 483-488
  • 11 Mahady K, Thust S, Berkeley R. et al. Vascular anomalies of the head and neck in children. Quant Imaging Med Surg 2015; 5 (06) 886-897
  • 12 Flors L, Leiva-Salinas C, Maged IM. et al. MR imaging of soft-tissue vascular malformations: diagnosis, classification, and therapy follow-up. Radiographics 2011; 31 (05) 1321-1340, discussion 1340–1341
  • 13 Morrow MS, Oliveira AM. Imaging of lumps and bumps in pediatric patients: an algorithm for appropriate imaging and pictorial review. Semin Ultrasound CT MR 2014; 35 (04) 415-429
  • 14 Stavros AT, Rapp CL, Parker SH. Nonmalignant breast disorders that have complex cystic phases. In: Stavros AT, Rapp CL, Parker SH, eds. Breast Ultrasound. Philadelphia, PA: Lippincott Williams and Wilkins 2004: 435-437
  • 15 Liu AS, Mulliken JB, Zurakowski D, Fishman SJ, Greene AK. Extracranial arteriovenous malformations: natural progression and recurrence after treatment. Plast Reconstr Surg 2010; 125 (04) 1185-1194
  • 16 Dubois J, Garel L. Imaging and therapeutic approach of hemangiomas and vascular malformations in the pediatric age group. Pediatr Radiol 1999; 29 (12) 879-893
  • 17 Dubois J, Patriquin HB, Garel L. et al. Soft-tissue hemangiomas in infants and children: diagnosis using Doppler sonography. AJR Am J Roentgenol 1998; 171 (01) 247-252
  • 18 Wiesinger I, Jung W, Zausig N. et al. Evaluation of dynamic effects of therapy-induced changes in microcirculation after percutaneous treatment of vascular malformations using contrast-enhanced ultrasound (CEUS) and time intensity curve (TIC) analyses. Clin Hemorheol Microcirc 2018; 69 (01/02) 45-57
  • 19 Legiehn GM, Heran MK. Classification, diagnosis, and interventional radiologic management of vascular malformations. Orthop Clin North Am 2006; 37 (03) 435-474, vii–viii
  • 20 Paltiel HJ, Burrows PE, Kozakewich HP, Zurakowski D, Mulliken JB. Soft-tissue vascular anomalies: utility of US for diagnosis. Radiology 2000; 214 (03) 747-754
  • 21 Bruckner AL, Frieden IJ. Hemangiomas of infancy. J Am Acad Dermatol 2003; 48 (04) 477-493, quiz 494–496
  • 22 Nord KM, Kandel J, Lefkowitch JH. et al. Multiple cutaneous infantile hemangiomas associated with hepatic angiosarcoma: case report and review of the literature. Pediatrics 2006; 118 (03) e907-e913
  • 23 Rogers M, Lam A, Fischer G. Sonographic findings in a series of rapidly involuting congenital hemangiomas (RICH). Pediatr Dermatol 2002; 19 (01) 5-11
  • 24 Nasseri E, Piram M, McCuaig CC, Kokta V, Dubois J, Powell J. Partially involuting congenital hemangiomas: a report of 8 cases and review of the literature. J Am Acad Dermatol 2014; 70 (01) 75-79
  • 25 Lee GK, Suh KJ, Lee JH. et al. Lobular capillary hemangioma in the soft tissue of the finger: sonographic findings. Skeletal Radiol 2010; 39 (11) 1097-1102
  • 26 Stout AP, Murray MR. Hemangiopericytoma: a vascular tumour featuring Zimmermann’s pericytes. Ann Surg 1942; 116 (01) 26-33
  • 27 Bhutia O, Roychoudhury A. Hemangiopericytoma of mandible. J Oral Maxillofac Pathol 2008; 12: 26-28
  • 28 Sinha A, Rawson K, Singh G. A rare case of hemangiopericytoma in the maxilla of a 4 year-old child. J Indian Acad Oral Med Radiol 2010; 22: 64-66
  • 29 Sarkar M, Mulliken JB, Kozakewich HP, Robertson RL, Burrows PE. Thrombocytopenic coagulopathy (Kasabach-Merritt phenomenon) is associated with Kaposiform hemangioendothelioma and not with common infantile hemangioma. Plast Reconstr Surg 1997; 100 (06) 1377-1386
  • 30 Lowe LH, Marchant TC, Rivard DC, Scherbel AJ. Vascular malformations: classification and terminology the radiologist needs to know. Semin Roentgenol 2012; 47 (02) 106-117
  • 31 Trop I, Dubois J, Guibaud L. et al. Soft-tissue venous malformations in pediatric and young adult patients: diagnosis with Doppler US. Radiology 1999; 212 (03) 841-845
  • 32 Dubois JM, Sebag GH, De Y Prost, Teillac D, Chretien B, Brunelle FO. Soft-tissue venous malformations in children: percutaneous sclerotherapy with Ethibloc. Radiology 1991; 180 (01) 195-198
  • 33 Puig S, Casati B, Staudenherz A, Paya K. Vascular low-flow malformations in children: current concepts for classification, diagnosis and therapy. Eur J Radiol 2005; 53 (01) 35-45
  • 34 Puig S, Aref H, Chigot V, Bonin B, Brunelle F. Classification of venous malformations in children and implications for sclerotherapy. Pediatr Radiol 2003; 33 (02) 99-103
  • 35 Donnelly LF, Adams DM, Bisset GS II. Vascular malformations and hemangiomas: a practical approach in a multidisciplinary clinic. AJR Am J Roentgenol 2000; 174 (03) 597-608
  • 36 Dubois J, Alison M. Vascular anomalies: what a radiologist needs to know. Pediatr Radiol 2010; 40 (06) 895-905
  • 37 Ozeki M, Fukao T. Generalized lymphatic anomaly and Gorham-Stout disease: overview and recent insights. Adv Wound Care (New Rochelle) 2019; 8 (06) 230-245
  • 38 Monroe EJ. Brief description of ISSVA classification for radiologists. Tech Vasc Interv Radiol 2019; 22 (04) 100628
  • 39 Amarneh M, Shaikh R. Clinical and imaging features in fibro-adipose vascular anomaly (FAVA). Pediatr Radiol 2020; 50 (03) 380-387
  • 40 Mulligan PR, Prajapati HJS, Martin LG, Patel TH. Vascular anomalies: classification, imaging characteristics and implications for interventional radiology treatment approaches. Br J Radiol 2014; 87 (10/35) 20130392
  • 41 Hartzell LD, Buckmiller LM. Current management of infantile hemangiomas and their common associated conditions. Otolaryngol Clin North Am 2012; 45 (03) 545-556, vii
  • 42 Frieden IJ, Haggstrom AN, Drolet BA. et al. Infantile hemangiomas: Current knowledge, future directions. Proceedings of a Research Workshop on Infantile Hemangiomas, April 7-9, 2005, Bethesda, Maryland USA. Pediatr Dermatol 2005; 22 (05) 383-406