AV MALFORMATION                            CASE BASED OVERVIEW<br />MERCURY IMAGING INSTITUTE <br />SCO 172-173 SEC 9C  CH...
PRESENT CASE<br />CLINICAL PROFILE : 45 yr female with                                                                 Swe...
VENOUS PHASE     <br />
TIW – LOBULATED LESION WITH INTERMEDIATE SIGNAL<br />SAGITTAL IMAGE –<br />LESION IS VENTRAL TO FLEXOR DIGITORUM LONGUS   ...
CORONAL IMAGES <br />
POSSIBILITY OF AVM IS KEPT<br />HIGH FLOW ON DOPPLER<br />PALPABLE SWELLING <br />NO PHLEBOLITH ON SOFT TISSUE RADIOGRAPH<...
DISCUSSION- DSA VERSUS MR ANGIO.<br /> DSA<br />      Preferred method for detection  of vascular pathology<br />Invasive ...
DIFFERENTIALS<br />GLOMUS TUMOR<br />Nail bed / Finger tips.<br />Common in  hands<br /> Recurrence <br />Pinpoint pain / ...
 The superficial Palmararch is formed mainly by the ulnar artery and is completed by the superficial branch of the radial ...
  Common upper extremity arterial anatomy: The ulnar artery supplies the superficial palmar arch, the major source of bloo...
  The deep palmar arch is supplied by the radial artery as it passes under the “snuff box” tendons and gives rise to the p...
AN APPROACH TOWARDS CONGENITAL AND DEVELOPMENTAL  VASCULAR ANOMALIES <br />
CONGENITAL AND DEVELOPMENTAL VASCULAR ANOMALIESY<br />ARTERIOVASCULAR MALFORMATIONS<br />PROLIFERATIVE VASCULAR LESIONS<br...
While diagnosing vascular lesions <br />SOME OF THE LESSONS LEARNT………………………….<br />Duration of pathology – congenital – in...
Avm
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Avm

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Avm

  1. 1. AV MALFORMATION CASE BASED OVERVIEW<br />MERCURY IMAGING INSTITUTE <br />SCO 172-173 SEC 9C CHANDIGARH<br />MERCURY IMAGING CENTRE <br />SCO 16-17 SEC 20D CHANDIGARH<br />
  2. 2. PRESENT CASE<br />CLINICAL PROFILE : 45 yr female with Swelling Rt hand index finger . Previous history of intervention present . ? glomustumor. No record of histopathologicale examination. Previous history of appendicectomy and deroofing of Rt ovarian cyst. Present study done to assess relation of the swelling to the digital arteries. <br /><ul><li>CONTRAST MR ANGIOGRAM DONE</li></li></ul><li><ul><li>ARTERIAL PHASE- Immediate post contrast enhancement with nonenhancingniduswhich shows diffuse enhancement after a while . </li></ul>NONENHANCING NIDUS<br />ARTERIAL COMPONENT OF THE LESION<br /> SUPRFICIAL PALMAR ARCH<br />ULNARARTERY<br /> DIFFUSE ENHANCEMENT OF THE LESION<br />
  3. 3. VENOUS PHASE <br />
  4. 4. TIW – LOBULATED LESION WITH INTERMEDIATE SIGNAL<br />SAGITTAL IMAGE –<br />LESION IS VENTRAL TO FLEXOR DIGITORUM LONGUS WITH A HYPOINTENSE NIDUS IN THE CRANIAL PART<br />STIR – HYPERINTENSE LESION<br />
  5. 5. CORONAL IMAGES <br />
  6. 6. POSSIBILITY OF AVM IS KEPT<br />HIGH FLOW ON DOPPLER<br />PALPABLE SWELLING <br />NO PHLEBOLITH ON SOFT TISSUE RADIOGRAPH<br />IMMEDIATE POST CONTRAST ENHANCEMENT<br />NIDUS APPRECIATED <br />DIFFUSE RELATIVELY DELAYED ENHANCEMENT <br />DRAINING VEINS APPRECIATED IN RELATION TO THE LESION<br />
  7. 7. DISCUSSION- DSA VERSUS MR ANGIO.<br /> DSA<br /> Preferred method for detection of vascular pathology<br />Invasive <br />Iodinated contrast agents <br />Radiation <br />May fail to demonstrate significant extraluminal disease.<br />MR ANGIO – WITH/WITTOUT CONTRAST <br />Flow related enhancement –TOF<br />Contrast – shortens t1 relaxation time.<br />Parallel imaging <br />Keyhole imaging<br />Challenge – timing of the contrast – bolus tracker . <br />
  8. 8. DIFFERENTIALS<br />GLOMUS TUMOR<br />Nail bed / Finger tips.<br />Common in hands<br /> Recurrence <br />Pinpoint pain / Paroxysmal pain/Cold hypersistivity.<br />Pain full Subcutaneous nodule in subungal position.<br />Hyperintense on t2w <br />High blood flow on doppler<br />HAEMANGIOMA<br />At birth – 30 %<br />4th wk – 70%<br />10- 14 years – maximum involute ( fibrofatty change) <br />Calcification on plain Radiographs .<br />
  9. 9.  The superficial Palmararch is formed mainly by the ulnar artery and is completed by the superficial branch of the radial artery.<br />©2008 by Radiological Society of North America<br />
  10. 10.   Common upper extremity arterial anatomy: The ulnar artery supplies the superficial palmar arch, the major source of blood flow to the digits.<br />©2008 by Radiological Society of North America<br />
  11. 11.   The deep palmar arch is supplied by the radial artery as it passes under the “snuff box” tendons and gives rise to the princepspollicis and deep palmar arch.<br />
  12. 12. AN APPROACH TOWARDS CONGENITAL AND DEVELOPMENTAL VASCULAR ANOMALIES <br />
  13. 13. CONGENITAL AND DEVELOPMENTAL VASCULAR ANOMALIESY<br />ARTERIOVASCULAR MALFORMATIONS<br />PROLIFERATIVE VASCULAR LESIONS<br />LOOK FOR MAJOR COMPONENT – ARTERIAL / VENOUS / CAPILLARY / LYMPHATIC AND DEFINE ACCORDINGLY.<br />NOT TRUE MITOTIC LESIONS <br />ARTERIAL LESIONS ARE – HIGH FLOW <br />VENOUS LESIONS – PHLEBOLITHS,DIFFUSE ENHANCEMENT, SEPTATIONS , LOBULATIONS.<br />LYMPHATIC – SEPTAL ENHANCEMENT , LOBULATION . <br />CAPILLARY – TOUGH TO DEFINE ON MR FOR THERE SUPERFICIAL LOCATIONS. <br />AVM – LOOK FOR NIDUS - EARLY ARTERIAL ENHANCEMENT – EARLY FILLING OF VEINS – TOURTUOS FEEDING ARTERIES - TORTUOS DRAINING VEINS –SECONDARY EFFECTS ON ORGANS <br />Infantile/ congenital haemangioma’s<br /> True Mitotic lesion<br />May or may not involute<br />Mass lesion with hyperintense signal on t2w sequence with homogenous enhancement. <br />
  14. 14. While diagnosing vascular lesions <br />SOME OF THE LESSONS LEARNT………………………….<br />Duration of pathology – congenital – infantile - acquired <br />Examine the Radiograph : Phlebolith , calcification.<br />Pain in the lesion- pinpointing ,paroxysmal – glomus tumor <br />Subungalsubcutaeoussmall lesion – glomus tumor<br />Tumor like look – proilferative vascular lesions<br />High flow lesions – primarily arterial<br />Nidus in the lesion – AV malformation<br />Arterial component – Early enhancement<br />Venous component – Diffuse ,Septal enhancement . PHLEBOLITHS <br />Lymphatic component- Septal pattern of enhancement <br />

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