Scattered Musculoskeletal Venous Malformations in Children: A Rare Report on Clinical Evaluation and Sclerotherapy with Adjunctive Stasis of Efflux.

Abstract

Venous malformations are rare lesions of unknown etiology, with a reported incidence of 0.8-1%. Patients with inexorable growth and expansion of vascular malformations, or" have an unpredictable clinical course and a wide range of presenting symptoms. Often, they are erroneously diagnosed and inadequately treated due to their rarity and lack of expertise among clinicians. To author's information this is the first report of diffuse venous malformations with multiple phleboliths involving various compartments of the upper extremity in children. The uthors discuss the clinical presentation, evaluation, and treatment over 8 months of slow-flow venous malformations with phleboliths in an11-year-old girl presenting with multiple painful swellings throughout her right upper extremity. The right upper extremity had multiple swellings over the right hand, forearm, arm, and shoulder region involving multiple compartments. The digital swellings had bluish discoloration, indicating a vascular nature. Blood tests revealed a raised D-dimer level (2.42 mg/L). Radiographs, Ultrasound, Magnetic resonance imaging, and CT angiography suggested a slow-flow venous malformation. The excisional biopsy confirmed the diagnosis. Ultrasound-guided Sclerotherapy with the Sclerotherapy with Adjunctive Stasis of Efflux Technique was performed for other lesions. Sodium Tetradecyl Sulfate (60 mg/2 mL; 0.5mL) was used in each lesion. Post-intervention, at 6 months follow-up, cosmetic appearance improved drastically, with the hands benefitted most. Parents were satisfied with overall outcome. Sclerotherapy was stopped after 4 cycles. Ultrasound-guided sclerotherapy is effective in treating venous malformations. The ideal result is seen after 4-5 sittings. Sclerotherapy must be performed in the operating theatre under sedation or appropriate anesthesia with resuscitation equipment at the ready disposal. Excision is reserved for bigger superficial lesions.