Oral 11, Potential life-threatening complications of vascular malformations

Abstract

We present two patients with vascular anomalies which illustrate important learning points. Patient 1 was a 7‐year‐old girl who was being followed up for a vascular malformation which had been present at birth and had slowly enlarged over the years. It was located midline, overlying her thoracic spine. Magnetic resonance (MR) imaging revealed the lesion to be an arteriovenous malformation. An MR angiogram, performed to delineate further the extent of involvement around the spine, surprisingly revealed multiple pulmonary arteriovenous malformations. The patient admitted to having regular nosebleeds but was otherwise asymptomatic and had no telangiectasia on her face or in her mouth. There was no family history of bleeding disorders. Genetic testing has confirmed hereditary haemorrhagic telangiectasia. We present this girl to highlight the significance of midline vascular lesions, which should be treated with suspicion and physicians should have a low threshold for investigation. Patient 2 was an 18‐year‐old man attending the multidisciplinary vascular anomalies clinic with an extensive lymphatic venous malformation present since birth. Imaging showed this involved the bladder and rectum, and extended the whole way down the left leg to include the foot. Over the years he was troubled with haematuria, rectal bleeding, and recurrent painful episodes. D‐dimers were elevated. His condition was complicated by bilateral extensive pulmonary emboli and he was started on low‐molecular‐weight heparin. Despite this he went on to suffer a fatal pulmonary embolus 2 months later. These cases highlight the associated risks of vascular malformations.