Imaging Sci Dent.  2015 Jun;45(2):123-131. 10.5624/isd.2015.45.2.123.

The current approach to the diagnosis of vascular anomalies of the head and neck: A pictorial essay

• Goel S
• Gupta S
• Singh A
• Prakash A
• Ghosh S
• Narang P
• Gupta S

• KMID: 2054215
• DOI: http://doi.org/10.5624/isd.2015.45.2.123

Abstract

Throughout the years, various classifications have evolved for the diagnosis of vascular anomalies. However, it remains difficult to classify a number of such lesions. Because all hemangiomas were previously considered to involute, if a lesion with imaging and clinical characteristics of hemangioma does not involute, then there is no subclass in which to classify such a lesion, as reported in one of our cases. The recent classification proposed by the International Society for the Study of Vascular Anomalies (ISSVA, 2014) has solved this problem by including non-involuting and partially involuting hemangioma in the classification. We present here five cases of vascular anomalies and discuss their diagnosis in accordance with the ISSVA (2014) classification. A non-involuting lesion should not always be diagnosed as a vascular malformation. A non-involuting lesion can be either a hemangioma or a vascular malformation depending upon its clinicopathologic and imaging characteristics.

Keyword

Hemangioma; Vascular Malformation; Classification; Neck

MeSH Terms

Classification
Diagnosis*
Head*
Hemangioma
Neck*
Vascular Malformations

Figure

• 

  Fig. 1 High-flow vascular malformation of the lower lip in a 49-year-old female. A. Swelling of the lower lip with a reddish tinge and bluish mucosal junction. B and C. Doppler ultrasonography images show heterogeneously echogenic soft tissue with a plexus of multiple tortuous and prominent vascular channels. D. A Doppler ultrasonography image displays systolic pulsatile blood flow suggestive of arteriovenous malformation. E. A T1-weighted axial magnetic resonance image shows an ill-defined, iso-intense lesion in the lower lip. F. A T2-weighted, fat-saturated sagittal magnetic resonance image shows a hyper-intense lesion with flow voids within the lower lip. G. A magnetic resonance angiographic image reveals tortuous vessels (short arrow) within the lesion deriving their supply from a branch of the left facial artery with an early draining vein (long arrow).

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  Fig. 2 Venous malformation of the left maxilla in an 18-year-old female. A. A photograph shows swelling of the left maxillary alveolus region with ill-defined margins, an irregular surface and displacement of teeth inferiorly with step formation. B. A panoramic radiograph shows an ill-defined radiolucent lesion in the left maxillary incisor canine region with sparse trabeculae. C. An axial non-contrast computed tomographic image shows an expansile lesion of the left maxillary region with coarse thickened trabeculae. D. The dynamic axial arterial phase-contrast computed tomographic image shows a soft tissue mass (long thin arrow) with a feeder vessel from the left facial artery (short thick arrow). E. The delayed-phase axial contrast-enhanced computed tomography image shows homogeneous enhancement of the lesion.

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  Fig. 3 Non-involuting congenital hemangioma in a 26-year-old female. A. A photograph shows facial asymmetry due to swelling in the left side of the mandible. B. A panoramic radiograph shows bone remodelling and resorption with scalloped margins in the left mandibular angle region with an overlying soft tissue component. C. A coronal contrast-enhanced computed tomographic image reveals multiple dilated vascular channels in the left mandibular angle region. D. An axial contrast-enhanced computed tomographic image reveals an ill-defined enhancing lesion infiltrating the left masseter and left pterygoid muscles with serpentine vascular channels within. E. A coronal T2-weighted magnetic resonance image reveals bulky deep and superficial lobes of the left parotid gland, with heterogeneous hyper-intensity superiorly and loss of fat planes with the adjacent muscles. No abnormal signal flow voids are evident. F. An axial T2-weighted magnetic resonance image reveals bulky deep and superficial lobes of the left parotid gland, with heterogeneous hyper-intensity involving the overlying fat planes. G. A Doppler ultrasonography image is suggestive of slow venous flow.

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  Fig. 4 A. A photograph shows slight facial asymmetry due to swelling in the left temporomandibular joint region. B. A panoramic radiograph reveals phleboliths posterior to the left maxillary tuberosity region (arrows). C. An axial delayed-phase contrast-enhanced computed tomographic image reveals heterogeneous contrast enhancement of the posterior lobe of left parotid gland with superficial extensions and phleboliths in the infratemporal fossa.

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  Fig. 5 A. A frontal contrast-enhanced computed tomographic (CECT) image of high-flow vascular malformation shows unusual presence of two separate lesions on the same side of the face. A tangle of serpiginous vessels are present in relation to the anterior belly of the digastric muscle and submandibular space on the left side. B. A coronal CECT image shows the lesion in the relation to the left sternocleidomastoid muscle. C. An axial CECT image shows the lesion in the relation to the posterior aspect of the superficial lobe of the left parotid gland. D and E. Doppler ultrasonography images show tortuous dilated vessels in the substance of the anterior belly of the digastric muscle with color flow within showing the arterial pattern. F. A Doppler ultrasonography image shows tortuous vessels in relation to the parotid gland, showing color flow within and the arterial pattern of flow.

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