Soft-tissue venous malformations in adult patients: Imaging and therapeutic issues

Venous malformations are the most common vascular malformations. However, c onfusion with respect to terminology and imaging guidelines continues to re sult in improper diagnosis and treatment. An appropriate classification sch eme for vascular anomalies is important to avoid the use of false generic t erms. Adequate imaging in association with clinical findings is crucial to establishing the correct diagnosis. Doppler ultrasonography should be the i nitial imaging modality and demonstrates absence of flow or low-velocity ve nous flow. Computed tomography and magnetic resonance (MR) imaging are used primarily for pretreatment evaluation of lesion extension. These lesions a re usually hypointense on T1-weighted MR images and markedly hyperintense o n T2-weighted images with variable gadolinium enhancement. Direct phlebogra phy helps confirm the diagnosis and exclude other soft-tissue tumors. Three distinct phlebographic patterns (cavitary, spongy, dysmorphic) have been i dentified. In most cases, conservative treatment is recommended. Sclerother apy with or without surgery is useful in cases of functional impairment or significant aesthetic prejudice, even if recurrences are frequent. Direct p hlebography is performed when a more detailed assessment of the vascular pa ttern is needed or as part of sclerotherapy. Use of the appropriate imaging technique is critical in establishing the diagnosis, evaluating extension, and planning appropriate treatment.