Percutaneous sinus angiography and three-dimensional CT imaging showing morphological and draining features of venous malformations in soft tissue.
OBJECTIVE
Venous malformation (VM) is a common vascular malformation in soft tissue. Its morphological and draining features, relationship with main vein, and hemodynamics in the lesion are not completely clear till now. Above information is important for choice of treatment.


METHODS
From January 2012 to December 2013, 23 patients were enrolled into this study. Percutaneous puncture into the lesion was made and contrast media was injected into venous sinus. Immediately after that CT scan was performed, and repeated several minutes later. Then three-dimensional imaging was performed to show the morphology and draining veins of VMs, and the relevant main veins. The hemodynamics in the lesion was also evaluated.


RESULTS
All patients underwent successful examination. Three-dimensional imaging showed an irregular shape of VM. Based on the draining features, VMs were classified into three types: (1) Type I (7/23): malformation without visible draining vein; (2) Type II (10/23): malformation with normal draining vein; (3) Type III (6/23): malformation with abnormal dilated draining vein. The flow in type I VMs was slow. Contrast media retained in the lesion for more than 1 day. The flow in type III VMs was fast. Contrast media flowed away rapidly. The flow of type II VMs was between type I and type III. According to above information and adjacent anatomy, all patients received suitable treatment, including sclerotherapy with absolute ethanol and bleomycin A5, intralesional copper wires retention, surgical removal, and combinational therapy of the above methods.


CONCLUSIONS
This procedure can clearly show the morphological and draining features of VM and its relationship with main vein, and further evaluate the hemodynamics in the lesion, which are helpful for the choice of treatment.
Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China yuansm@163.com.
Si-Ming
SM
Yuan
Department of Radiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China.
Chang-Sheng
CS
Zhou
Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China.
Lei
L
Cui
Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China.
Yao
Y
Guo
Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China.
Jun
J
Wang
Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China.
Xin-Bao
XB
Hu
Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China.
Ji-Hong
JH
Zhou
Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China.
Zhi-Jian
ZJ
Hong
Department of Plastic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China.
Hui-Qing
HQ
Jiang
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D014057:Tomography, X-Ray Computed; D054079:Vascular Malformations / Q000145:classification / Q000000981:diagnostic imaging / Q000503:physiopathology; D014680:Veins / Q000503:physiopathology*
Venous malformation; draining vein; percutaneous sinus angiography; three-dimensional CT imaging