[Imaging in diagnosis and treatment of vascular lesions of the hand].
Vascular lesions of the hand are challenging for diagnosis and treatment. These lesions are far more common than malignant tumors. Clinical presentation may be confusing and correct identification by imaging is sometimes mandatory. Standard X-rays and doppler ultrasound examination are the first modalities to be used. Doppler ultrasound help to characterize the lesion or/and to assess the flow velocity within the lesion. It allows to separate the high flow lesions (hemangioma, arteriovenous malformation) from the low or no flow lesions (venous malformation, cystic lymphangioma). MR imaging is the gold examination to define the size and the extension of the lesion to adjacent structures. Careful clinical and imaging evaluation and multidisciplinary staff decision are crucial before to propose embolotherapy and/or surgical treatment. In case of persistent doubt, a biopsy must be required. AVM must be excluded before to propose this biopsy sample. Interventional radiology can be used alone or in combination with surgery to treat vascular malformation (arteriovenous, lymphatic, venous, or mixed). Embolisation may either be done by percutaneous approach (all malformations) or by intravascular catheterization (arteriovenous malformation). Hemangioma is a benign tumor which most often spontaneously involutes with age. Vascular malformations of the hand are difficult to eradicate completely either with embolization or surgery or both. Recurrences are frequent. Management in multidisciplinary staff is mandatory and long follow-up is needed.
Service de radiopédiatrie, hôpital Timone-Enfants, 264, rue St-Pierre, 13385 Marseille cedex 05, France. philippe.petit@mail.ap-hm.fr
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D001165:Arteriovenous Malformations / Q000175:diagnosis / Q000601:surgery / Q000628:therapy; D003937:Diagnosis, Differential; D004621:Embolization, Therapeutic; D006225:Hand / Q000098:blood supply* / Q000601:surgery; D006391:Hemangioma / Q000175:diagnosis / Q000601:surgery / Q000628:therapy; D006801:Humans; D018191:Lymphangioma, Cystic / Q000175:diagnosis / Q000601:surgery / Q000628:therapy; D008279:Magnetic Resonance Imaging; D011859:Radiography; D015642:Radiology, Interventional; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D054079:Vascular Malformations / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy
Approche diagnostique et thérapeutique en imagerie des anomalies vasculaires de la main.