Introduction
Peripheral vascular malformations has a wide spectrum of lesions which can be found incidentally or symptomatically as slow growing painless swelling or painful if it has intra-articular or intra-osseous extension.
It involves all the vascular trees that includes arteries, veins, capillaries as well as lymphatics.
Ultrasound being primary modality of choice along with detailed clinical history and examination play a crucial role in diagnosing the type of lesion and its extent.1, 2, 3
Classifications
It can be classified based on flow dynamics into:
Slow flow vascular malformations.
High flow vascular malformations.
Complex/Mixed vascular malformations.4
Aims and Objectives
The purpose of this study is to perform duplex ultrasonographic examination as primary modality of choice in patients presenting with complaints of slow growing painless swelling in peripheral regions that leads to diagnosing various types of vascular malformation primarily, with its extent and various types.
Materials and Methods
A study of 50 patients was carried over a period of 1 year from 1st May 2021 to
1st May 2022 on the patient who came with complain of slow growing, superficial swelling which is painless in nature. The machine used is Affinity Philips 70 G.
Table 1
Characteristics
Light to dark blue
Empty by light compression If superficial
No thrill/bruit, No warmth
Painless on palpation unless thrombosis
Can arise from any tissue including bone5
Figure 3
Shows ill-defined heterogeneously hypoechoic mass lesion withmultiple cystic spaces within intramuscular plane on flexor aspect of forearm.
Ultrasound findings
USG images shows ill-defined heterogeneously hypoechoic mass lesion with multiple cystic spaces within intramuscular plane on flexor aspect of forearm. There is evidence of multiple phleboliths within it. On color doppler study, weak signal venous flow is noted within the lesion. There in no communication noted between the lesion and the arterial supply.
Incidence of Various Vascular Malformations
In our study of 50 patients within limited period of 1 year, various types of vascular malformation have been diagnosed with incidence rate as described.
Conclusion & Discussion
From our study, we conclude that Ultrasound acts as primary modality of choice in diagnosing various types of malformations and its extent. We conclude that with detailed history, clinical examination and ultrasound Examination:
Slow flow venous malformation remained as more frequently encountered vascular malformations. Its characteristic ultrasound features are cystic spaces within the soft tissue mass lesion, presence of phlebolith which being characteristic feature.10 Lymphatic malformations have its typical location, with characteristic sonographic features as anechoic cystic lesion with thick septations and may encase the adjacent structures. On colour doppler, the septations may or may not show internal vascularity.11
Arterio-venous malformations mainly present in adulthood or adolescence period with high flow velocity and low resistance vascular malformation,12 however no discrete mass lesion seen. Capillary malformations also known as portwine stain are based on clinical diagnosis
Ultrasound imaging has no role in diagnosing it. MRI plays important role to rule out its association with various syndrome such as Sturge-weber syndrome, Klippel- Trenauny Syndrome etc.3
The study of flow dynamics can be made by contrast based MRI which remain as Preferred modality of choice as it gives detailed extent of the lesion with its characteristics. Graph is plotted with variables as arterial lesion time, maximum enhancement time and slope provides significant information to differentiate between slow flow vs high flow malformations.13, 14
