Multiple Low Flow Vascular Malformation with Phleboliths – A Case Report

Abstract

: Objective: Venous malformation involving head and neck region is a rare entity. Hence, application of precise and leading diagnostic techniques, gives the accurate localization of the source vessel allowing for making treatment plan more satisfactory. Methods: We present a case of 30-year-old male patient with venous malformation involving head and neck region. We update the review of literature and also discuss the leading diagnostic aids for this rare entity disease so that iatrogenical accidents can be lessened. Case description: Our patient presented with solitary swelling in the left lower cheek region, left side of lateral border of tongue and 2 – 3 small nodular swellings at the lateral border of the neck, lined obliquely over the sternocleidomastoid muscle. All the swellings were soft in consistency and non-tender, with no rise in temperature except for the swelling on the tongue. The lesion was confirmed by a radiograph which showed phleboliths. The ultrasound shows heterogeneously hypoechoic with multiple anechoic sinusoidal spaces (longitudinal plane) with mild vascularization and spectral analysis shows monophasic venous flow. This was later confirmed by direct puncture venography of the left cheek. Conclusion: The spectrum of vascular malformations is too vast; hence it becomes challenging to diagnose the lesion and fit it in the spectrum. These lesions are termed as intramuscular venous malformations based on clinical imaging and pathologic criteria and hence dentists must be aware of the clinical expression of these lesions in order to prevent iatrogenically related accidents and to minimize potential spontaneous crises for the patient. Having said that and keeping in mind the broad spectrum of vascular malformation, we present a clinically well diagnosed case of venous malformation, which illustrates phleboliths.Key words: Venous malformations (VMs), Arteriovenous malformation (AVM), Phleboliths, sclerotherapy, Venography and Hemangioma.