Skip to main content

Advertisement

Log in

Multimodality imaging of vascular anomalies

  • Pediatric Musculoskeletal Imaging: Beyond the Basics
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Vascular malformations and hemangiomas are common in children but remain a source of confusion during diagnosis, in part because of the lack of a uniform terminology. With the existing treatments for hemangiomas and vascular malformations, it is important to make the correct diagnosis initially to prevent adverse physical and emotional sequelae in not only the child but also the family. The diagnosis of vascular malformations is made primarily by the clinician and based on the physical exam. Imaging is carried out using predominantly ultrasound (US) and magnetic resonance imaging (MRI), which are complementary modalities. In most cases of vascular anomalies, US is the first line of imaging as it is readily available, less expensive, lacks ionizing radiation and does not require sedation. MRI is also of great help for further characterizing the lesions. Conventional arteriography is reserved for cases that require therapeutic intervention, more commonly for arteriovenous malformations. Radiographs usually play no role in diagnosing vascular anomalies in children. In this article, the author describes the terminology and types of hemangiomas and vascular malformations and their clinical, histological features, as well as the imaging approach and appearance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Fig. 20
Fig. 21
Fig. 22

Similar content being viewed by others

References

  1. Hassanein AH, Mulliken JB, Fishman SJ et al (2011) Evaluation of terminology for vascular anomalies in current literature. Plast Reconstr Surg 127:347–351

    Article  PubMed  CAS  Google Scholar 

  2. Boye E, Jinnin M, Olsen B (2009) Infantile hemangioma: challenges, new insights, and therapeutic options. J Craniofac Surg 20:678–684

    Article  PubMed  Google Scholar 

  3. Enjolras O, Mulliken JB (1997) Vascular tumors and vascular malformations (new issues). Adv Dermatol 13:375–423

    PubMed  CAS  Google Scholar 

  4. Restrepo R, Palani R, Cervantes LF et al (2011) Hemangiomas revisited: the useful, the unusual and the new. Part 1: overview and clinical and imaging characteristics. Pediatr Radiol 41:895–904

    Article  PubMed  Google Scholar 

  5. Dompmartin A, Vikkula M, Boon L (2010) Venous malformation: update on etiopathogenesis and management. Phlebology 25:224–235

    Article  PubMed  CAS  Google Scholar 

  6. Haggstrom AN, Drolet BA, Baselga E et al (2007) Prospective study of infantile hemangiomas: demographic, prenatal and perinatal characteristics. J Pediatr 150:291–294

    Article  PubMed  Google Scholar 

  7. Bruder E, Alaggio R, Kozakewich HP et al (2012) Vascular and perivascular lesions of skin and soft tissues in children and adolescents. Pediatr Devel Pathol 15:26–61

    Article  Google Scholar 

  8. North PE, Waner M, Mizeracki A et al (2000) GLUT1: a newly discovered immunohistochemical marker for juvenile hemangiomas. Hum Pathol 31:11–22

    Article  PubMed  CAS  Google Scholar 

  9. Lowe LH, Marchant TC, Rivard D et al (2012) Vascular malformations: classification and terminology the radiologist needs to know. Semin Roentgenol 47:106–117

    Article  PubMed  Google Scholar 

  10. Mulliken JB, Enjolras O (2004) Congenital hemangiomas and infantile hemangiomas: missing links. J Am Acad Dermatol 50:875–882

    Article  PubMed  Google Scholar 

  11. Dubois J, Alison M (2010) Vascular anomalies: what a radiologist needs to know. Pediatr Radiol 40:895–905

    Article  PubMed  Google Scholar 

  12. Gorincour G, Kokta V, Rypens F et al (2005) Imaging characteristics of two subtypes of congenital hemangiomas: rapidly involuting congenital hemangiomas and non involuting congenital hemangiomas. Pediatr Radiol 35:1178–1185

    Article  PubMed  Google Scholar 

  13. Walter JW, North PE, Warner M et al (2002) Somatic mutation of vascular endothelial growth factors receptors in juvenile hemangioma. Genes Chromosomes Canc 33:295–303

    Article  CAS  Google Scholar 

  14. Puig S, Casati B, Staudenherz A et al (2005) Vascular low-flow malformations in children: current concepts for classification, diagnosis and therapy. Eur J Radiol 53:35–45

    Article  PubMed  Google Scholar 

  15. Greene AK, Rogers GF, Mulliken JB (2007) Intrasosseous hemangiomas are malformations and not tumors. Plast Reconstr Surg 119:1949–1950, author reply 1950

    Article  PubMed  CAS  Google Scholar 

  16. Bruder E, Perez-Atayde AR, Jundt G et al (2009) Vascular lesions of bone in children, adolescents and young adults. A clinicopathological reappraisal and application of the ISSVA classification. Virchows Arch 454:161–179

    Article  PubMed  Google Scholar 

  17. Cahill AM, Nijs E, Ballah D et al (2011) Percutaneous sclerotherapy in neonatal and infant head and neck lymphatic malformations: a single center experience. J Pediatr Surg 46:2083–2095

    Article  PubMed  Google Scholar 

  18. Legiehn GM, Heran MKS (2006) Classification, diagnosis, and interventional radiologic management of vascular malformations. Orthop Clin North Am 37:435–474

    Article  PubMed  Google Scholar 

  19. Jeltsch M, Tammela T, Alitalo K et al (2003) Genesis and pathogenesis of lymphatic vessels. Cell Tissue Res 314:69–84

    Article  PubMed  CAS  Google Scholar 

  20. Ernemann U, Kramer U, Miller S et al (2010) Current concepts in the classification, diagnosis and treatment of vascular anomalies. Eur J Radiol 75:2–11

    Article  PubMed  Google Scholar 

  21. Narang T, Dipankar D, Dogra S (2011) Lymphangioma circumscriptum and Whimster’s hypothesis revisited. Skinmed 9:123–124

    PubMed  Google Scholar 

  22. Patel G, Schwartz RA (2009) Cutaneous lymphangioma circumscriptum:frog spawn on the skin. Int J Dermatol 48:1290–1295

    Article  PubMed  Google Scholar 

  23. Boon LM, Baliieux F, Vikkula M (2011) Pathogenesis of vascular anomalies. Clin Plast Surg 38:7–19

    Article  PubMed  Google Scholar 

  24. Garzon MC, Huang JT, Enjolras O et al (2007) Vascular malformations. Part I. J Am Acad Dermatol 56:353–370

    Article  PubMed  Google Scholar 

  25. Dompmartin A, Ballieux F, Thibon P et al (2009) Elevated D-Dimer level in the differential diagnosis of venous malformations. Arch Dermatol 145:1239–1244

    Article  PubMed  CAS  Google Scholar 

  26. Leigiehn GM, Heran MK (2010) A step-by-step practical approach to imaging, diagnosis and interventional radiologic therapy in vascular malformations. Semin Intervent Radiol 27:209–231

    Article  Google Scholar 

  27. Redondo P, Aguado L, Martinez-Cuesta A (2011) Diagnosis and management of extensive vascular malformation of the lower limb. Part I Clinical diagnosis. J Am Acad Dermatol 65:893–906

    Article  PubMed  Google Scholar 

  28. Enjolras O, Ciabrini D, Mazoyer E et al (1997) Extensive pure venous malformations in the upper or lower limb: a review of 27 cases. J Am Acad Dermatol 36:219–226

    Article  PubMed  CAS  Google Scholar 

  29. Kubiena HF, Liang MG, Mulliken JB (2006) Genuine diffuse phlebectasia of Bockenheimer: dissection of an eponym. Pediatr Dermatol 23:294–297

    Article  PubMed  Google Scholar 

  30. Dompmartin A, Acher A, Thibon P et al (2008) Association of localized intravascular coagulopathy with venous malformations. Arch Dermatol 144:873–877

    Article  PubMed  Google Scholar 

  31. Hein KD, Mulliken JB, Kozakewich HPW et al (2002) Venous malformations of skeletal muscle. Plast Reconst Surg 110:1625–1635

    Article  PubMed  Google Scholar 

  32. Allen PW, Enzinger FM (1972) Hemangioma of skeletal muscle. Cancer 29:8–22

    Article  PubMed  CAS  Google Scholar 

  33. Ohgiya Y, Hashimoto T, Gokan T et al (2005) Dynamic MRI for distinguishing high-flow from low-flow peripheral vascular malformations. Am J Roentgenol 185:1131–1137

    Article  Google Scholar 

  34. Kim JS, Chandler A, Borzykowksi R et al (2012) Maximizing time-time resolved MRA for differentiation of hemangiomas, vascular malformations and vascularized tumors. Pediatr Radiol 42:775–784

    Article  PubMed  Google Scholar 

  35. Mostardi PM, Young PM, McKusick MA et al (2012) High temporal and spatial resolution imaging of peripheral vascular malformations. J Magn Reson Imaging 36:933–942

    Article  PubMed  Google Scholar 

  36. Burrows PE, Laor T, Paltiel H et al (1998) Diagnostic imaging in the evaluation of vascular birthmarks. Pediatr Dermatol 16:455–488

    CAS  Google Scholar 

Download references

Disclaimer

The author has no financial interests, investigational or off-label uses to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ricardo Restrepo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Restrepo, R. Multimodality imaging of vascular anomalies. Pediatr Radiol 43 (Suppl 1), 141–154 (2013). https://doi.org/10.1007/s00247-012-2584-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-012-2584-y

Keywords

Navigation