Answer:
Venous malformation
Findings:
There is an intramasseteric soft tissue lesion with phleboliths. On contrast study,the lesion has progressive and complete (persistent) enhancement on delayed studies.
Discussion:
Venous malformations (VMs) are vascular malformations that consist of dysplastic venous channels. VMs are present at birth, but the age of presentation depends on size,location and interference with normal function. The characteristic imaging feature of VMs is the development of phleboliths associated with phlebothrombosis.Early CT or MR images acquired during or immediately after bolus administration of IV contrast demonstrateenhancement of the VM that is initially heterogeneous. Delayed images show a more homogeneous pattern ofenhancement. It is important, from a therapeutic standpoint, to differentiate VM from hemangioma. The term cavernous hemangioma should be avoided when referring toVMs, as it is erroneous and frequently leads to the institution of inappropriate antiangiogenic drug therapy and subsequent therapeutic failure.
Reference- Head and neck imaging- Som & Curtin- Fourth edition.
Contributed By: Dr. Arun Chelladurai MD, Dr. Karunakaran M. Kalathi MD
Consultant Radiologists, Aarthi Scans, Thirunelveli, Tamilnadu, India
Venous malformation
Findings:
There is an intramasseteric soft tissue lesion with phleboliths. On contrast study,the lesion has progressive and complete (persistent) enhancement on delayed studies.
Discussion:
Venous malformations (VMs) are vascular malformations that consist of dysplastic venous channels. VMs are present at birth, but the age of presentation depends on size,location and interference with normal function. The characteristic imaging feature of VMs is the development of phleboliths associated with phlebothrombosis.Early CT or MR images acquired during or immediately after bolus administration of IV contrast demonstrateenhancement of the VM that is initially heterogeneous. Delayed images show a more homogeneous pattern ofenhancement. It is important, from a therapeutic standpoint, to differentiate VM from hemangioma. The term cavernous hemangioma should be avoided when referring toVMs, as it is erroneous and frequently leads to the institution of inappropriate antiangiogenic drug therapy and subsequent therapeutic failure.
Reference- Head and neck imaging- Som & Curtin- Fourth edition.
Contributed By: Dr. Arun Chelladurai MD, Dr. Karunakaran M. Kalathi MD
Consultant Radiologists, Aarthi Scans, Thirunelveli, Tamilnadu, India