Click the arrow to see the next slide with the correct interpretation.
12-Year-Old with Facial Swelling
This case features a 12-year-old presenting with facial swelling, ultimately diagnosed with a venous malformation.
Imaging overview:
Coronal STIR MRI demonstrates a lobular, T2-hyperintense transpatial lesion in the face with internal phleboliths appearing as foci of signal void. Axial T1 fat-saturated post-contrast MRI shows the characteristic delayed, puddling enhancement pattern of a venous malformation.
Clinical insight:
Venous malformations are low-flow vascular anomalies that typically present in childhood or adolescence as soft, compressible masses that increase in size with Valsalva maneuver or crying due to venous engorgement. On MRI, the lobular T2-hyperintense transpatial morphology with delayed puddling enhancement is characteristic. Internal phleboliths, which appear hyperdense on CT and as T1/T2 hypointense foci on MRI, are pathognomonic when present. Venous malformations can present acutely with pain and rapid enlargement in the setting of internal thrombosis, which may prompt urgent imaging evaluation. Unlike hemangiomas, venous malformations do not involute spontaneously and may require sclerotherapy or surgical management.
Case courtesy of Alexandra Foust, DO, Vanderbilt University Medical Center.