Soft tissue venous malformations
Updates to Article Attributes
Soft tissue venous malformations,commonly known as soft tissue haemangiomas, are a location-dependent benign vascular soft tissue tumour.
They are the most common angiomatous lesion and represent up to 7% of all benign soft-tissue tumours 2.
Terminology
It is important to note that according to newer nomenclature (ISSVA classification of vascular anomalies) these lesions are merely known as slow flow venous malformations. Having said that it is probably helpful in reports to include the word 'hemangioma' as this term is ubiquitous in the literature and most familiar to many clinicians. The remainder of this article uses the terms 'soft tissue hemangioma' and 'soft tissue venous malformation' interchangeably.
Epidemiology
There may be an greater female predilection.In the paediatric population, heamangiomas tends to be the most frequently diagnosed soft-tissue neoplasm.
Pathology
Sub types
Soft tissue haemangiomas may be classified in to five histological sub types.
This classification is dependent on the predominant type of vascular channel identified within them:
- capillary-commonest type and tend to predominate in the paediatric population.
- cavernous
- arteriovenous
- venous
- mixed
Location
They can arise in various anatomic locations, including striated muscle, skin, subcutaneous tissue, and synovial tissue (synovial haemangioma).
Radiographic features
Plain film
Small lesions may be occult of plain film which large lesions may show evidence of a focal soft tissue swelling +/- associated phleboliths.
Ultrasound
Can have a variable appearance. Typically seen as an ill-defined or well-defined hypoechoic mass of heterogeneous echotexture with multiple cystic spaces within. On Colour Doppler, there may be no detectable signal or only weak colour Doppler signal 13.
CT
On unenhanced CT, it may appear as an ill-defined mass of similar attenuation to muscle may be identified. CT may also identify the presence of associated phleboliths.
MRI
Haemangiomas are typically well-defined, lobulated and heterogeneous with no features of local invasion.
While many sequences show a rather heterogeneous signal mass certain signal characteristics tend to dominate.
-
T1:
- overall signal is often intermediate to slightly high signal (relative to skeletal muscle) 6
- some focal high signal areas may be present in a large proportion of lesions (up to 70% 5,9)
- T2: high signal intensity tends to dominate on T2-weighted images
- gradient echo: the presence of pheboliths may show blooming artefact 10
- T1 C+ (Gd): lesions show marked signal enhancement in parts of the areas, which were both of high and low T2 8
Some intramuscular hemangiomas may also associated atrophic changes in muscles
-</ul><h5>Location</h5><p>They can arise in various anatomic locations, including striated muscle, skin, subcutaneous tissue, and synovial tissue (<a href="/articles/synovial-haemangioma">synovial haemangioma</a>).</p><h4>Radiographic features</h4><h5>Plain film</h5><p>Small lesions may be occult of plain film which large lesions may show evidence of a focal soft tissue swelling +/- associated <a href="/articles/phleboliths">phleboliths</a>.</p><h5>CT</h5><p>On unenhanced CT, it may appear as an ill-defined mass of similar attenuation to muscle may be identified. CT may also identify the presence of associated phleboliths.</p><h5>MRI</h5><p>Haemangiomas are typically well-defined, lobulated and heterogeneous with no features of local invasion.</p><p>While many sequences show a rather heterogeneous signal mass certain signal characteristics tend to dominate.</p><ul>- +</ul><h5>Location</h5><p>They can arise in various anatomic locations, including striated muscle, skin, subcutaneous tissue, and synovial tissue (<a href="/articles/synovial-haemangioma">synovial haemangioma</a>).</p><h4>Radiographic features</h4><h5>Plain film</h5><p>Small lesions may be occult of plain film which large lesions may show evidence of a focal soft tissue swelling +/- associated <a href="/articles/phleboliths">phleboliths</a>.</p><h5>Ultrasound</h5><p>Can have a variable appearance. Typically seen as an ill-defined or well-defined hypoechoic mass of heterogeneous echotexture with multiple cystic spaces within. On Colour Doppler, there may be no detectable signal or only weak colour Doppler signal <sup>13</sup>. </p><h5>CT</h5><p>On unenhanced CT, it may appear as an ill-defined mass of similar attenuation to muscle may be identified. CT may also identify the presence of associated phleboliths.</p><h5>MRI</h5><p>Haemangiomas are typically well-defined, lobulated and heterogeneous with no features of local invasion.</p><p>While many sequences show a rather heterogeneous signal mass certain signal characteristics tend to dominate.</p><ul>
References changed:
- 12. Paltiel H, Burrows P, Kozakewich H, Zurakowski D, Mulliken J. Soft-Tissue Vascular Anomalies: Utility of US for Diagnosis. Radiology. 2000;214(3):747-54. <a href="https://doi.org/10.1148/radiology.214.3.r00mr21747">doi:10.1148/radiology.214.3.r00mr21747</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/10715041">Pubmed</a>
- 13. Keng C, Lan H, Chen C, Gueng M, Su Y, Lee S. Soft Tissue Hemangiomas: High-Resolution Grayscale and Color Doppler Ultrasonographic Features in 43 Patients. J Med Ultrasound. 2008;16(3):223-30. <a href="https://doi.org/10.1016/s0929-6441(08)60051-x">doi:10.1016/s0929-6441(08)60051-x</a>
- 14. Toprak H, Kiliç E, Serter A, Kocakoç E, Ozgocmen S. Ultrasound and Doppler US in Evaluation of Superficial Soft-Tissue Lesions. J Clin Imaging Sci. 2014;4:12. <a href="https://doi.org/10.4103/2156-7514.127965">doi:10.4103/2156-7514.127965</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/24744969">Pubmed</a>
Unable to process the form. Check for errors and try again.