Imaging Sci Dent.  2014 Mar;44(1):67-73. 10.5624/isd.2014.44.1.67.

Diverse imaging characteristics of a mandibular intraosseous vascular lesion

• Handa H
• Naidu GS
• Dara BG
• Deshpande
• Raghavendra R

• KMID: 1974476
• DOI: http://doi.org/10.5624/isd.2014.44.1.67

Abstract

Intraosseous vascular lesions of the maxillofacial region are rare, and the differential diagnosis of intraosseous vascular malformations from other jaw lesions can be challenging. In the present case, magnetic resonance imaging and three-dimensional computed tomographic angiography (CTA) was used for diagnosis, and the lesion was treated wih surgical excision. Diverse characteristics such as the "honeycomb" and "sunburst" radiographic appearances and the absence of major peripheral feeder vessels in the CTA were noted. Intraosseous vascular malformations have a varied radiographic appearance, and the nomenclature of these lesions is equally diverse, with several overlapping terms. Pathologists do not generally differentiate among intraosseous vascular lesions on the basis of histopathology, although these lesions may present with contrasting immunohistochemical and clinical behaviors requiring varied treatment strategies. This case report highlights the need for multiple imaging modalities to differentiate among vascular lesions, as well as to better understand the behaviors of these unique lesions.

Keyword

Vascular Malformation, Primary Intraosseous; Angiography; Tomography, X-Ray Computed; Magnetic Resonance Imaging

MeSH Terms

Angiography
Diagnosis
Diagnosis, Differential
Jaw
Magnetic Resonance Imaging
Tomography, X-Ray Computed
Vascular Malformations

Figure

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  Fig. 1 An intraoral photograph shows a dome shaped bluish alveolar swelling in the left mandibular premolar region.

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  Fig. 2 A. A panoramic radiograph shows a multilocular radiolucent lesion in the premolar region with small loculations giving a 'honeycomb appearance'. B. An occlusal radiograph shows a periosteal reaction as a "sun-burst" appearance. C. An intraoral periapical radiograph shows a multilocular radiolucent lesion in the premolar region with small loculations.

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  Fig. 3 Histopathologic examination shows frank blood aspirate with cytology showing plenty of red blood cells (H&E stain, 45×).

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  Fig. 4 A. CT images show trabeculated lesion in left hemi-mandible, with vascular lesion and feeder vessel seen supplying the lesion. B. A 3-dimensional CT angiogram shows a vascular lesion and feeder vessel.

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  Fig. 5 A. A coronal T1 weighted MR image shows an expansile low intensity lesion in marrow of left hemi-mandible. B. An axial T1 weighted MR image shows low signal intensity expansile lesion in marrow of left hemi-mandible with cortical break. C. An axial T2 weighted MR image shows a high signal expansile lesion in marrow of left hemi-mandible with cortical break.

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  Fig. 6 Histopathologic examination shows plump blood vessels in a fibrous stroma suggestive of vascular malformation (A. H&E stain, 10×, B. H&E stain, 45×).

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