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Vascular Malformations
Stephanie A. Bernard, MD
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KEY FACTS

  • Terminology

    • Imaging

      TERMINOLOGY

      • Abbreviations

        • Capillary malformation (Cap M)
        • Cavernous malformation (Cav M)
        • Venous malformation (VM)
        • Arteriovenous malformation (AVM)
      • Definitions

        • Terminology used inconsistently in MSK radiology literature
          • Adult MSK radiology literature often refers to slow-flow vascular malformations as hemangiomas and high flow as AVMs
          • WHO soft tissue tumor classification uses hemangioma and vascular malformation interchangeably, relying on imaging and clinical scenarios for differentiation
          • International Society of the Study of Vascular Anomalies (ISSVA), which has created most widely used classification system, distinguishes benign vascular tumors (hemangiomas and others) from vascular malformations
            • As many soft tissue benign neoplastic hemangiomas occur in pediatric population, use of hemangioma in pediatric radiology literature more closely follows ISSVA classification
            • ISSVA hemangioma: benign neoplastic vascular tumor composed of vessels with endothelial cellular proliferation
            • Vascular malformation: nonneoplastic localized abnormality in development of vessels with inappropriate connections but lacking endothelial hyperplasia; may include veins, capillaries, arteries, or combinations of any of these vessels and lymphatics

      IMAGING

      • General Features

        • Radiographic Findings

          • CT Findings

            • MR Findings

              • Ultrasonographic Findings

                • Angiographic Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      Selected References

                                      1. Green JR et al: Spectrum of imaging manifestations of vascular malformations and tumors beyond childhood: what general radiologists need to know. Radiol Clin North Am. 58(3):583-601, 2020
                                      2. Hussein A et al: Imaging of vascular malformations. Radiol Clin North Am. 58(4):815-30, 2020
                                      3. Pimpalwar S: Vascular malformations: approach by an interventional radiologist. Semin Plast Surg. 28(2):91-103, 2014
                                      4. Behr GG et al: Vascular anomalies: hemangiomas and beyond--part 1, fast-flow lesions. AJR Am J Roentgenol. 200(2):414-22, 2013
                                      5. Behr GG et al: Vascular anomalies: hemangiomas and beyond--part 2, slow-flow lesions. AJR Am J Roentgenol. 200(2):423-36, 2013
                                      6. Flors L et al: MR imaging of soft-tissue vascular malformations: diagnosis, classification, and therapy follow-up. Radiographics. 31(5):1321-40; discussion 1340-1, 2011
                                      7. Navarro OM et al: Pediatric soft-tissue tumors and pseudotumors: MR imaging features with pathologic correlation: part 1. Imaging approach, pseudotumors, vascular lesions, and adipocytic tumors. Radiographics. 29(3):887-906, 2009
                                      8. Weiss SW et al: Benign tumors and tumor-like lesions of blood vessels. In Weiss SW et al: Enzinger and Weiss' Soft Tissue Tumors. 5th ed. Elsevier. 633-64, 2008
                                      9. Calonje E: Haemangiomas. In Fletcher CDM et al: World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of Soft Tissue and Bone. IARC Press. 156-8, 2002
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          TERMINOLOGY

                                          • Abbreviations

                                            • Capillary malformation (Cap M)
                                            • Cavernous malformation (Cav M)
                                            • Venous malformation (VM)
                                            • Arteriovenous malformation (AVM)
                                          • Definitions

                                            • Terminology used inconsistently in MSK radiology literature
                                              • Adult MSK radiology literature often refers to slow-flow vascular malformations as hemangiomas and high flow as AVMs
                                              • WHO soft tissue tumor classification uses hemangioma and vascular malformation interchangeably, relying on imaging and clinical scenarios for differentiation
                                              • International Society of the Study of Vascular Anomalies (ISSVA), which has created most widely used classification system, distinguishes benign vascular tumors (hemangiomas and others) from vascular malformations
                                                • As many soft tissue benign neoplastic hemangiomas occur in pediatric population, use of hemangioma in pediatric radiology literature more closely follows ISSVA classification
                                                • ISSVA hemangioma: benign neoplastic vascular tumor composed of vessels with endothelial cellular proliferation
                                                • Vascular malformation: nonneoplastic localized abnormality in development of vessels with inappropriate connections but lacking endothelial hyperplasia; may include veins, capillaries, arteries, or combinations of any of these vessels and lymphatics

                                          IMAGING

                                          • General Features

                                            • Radiographic Findings

                                              • CT Findings

                                                • MR Findings

                                                  • Ultrasonographic Findings

                                                    • Angiographic Findings

                                                      • Nuclear Medicine Findings

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              • Gross Pathologic & Surgical Features

                                                                • Microscopic Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          Selected References

                                                                          1. Green JR et al: Spectrum of imaging manifestations of vascular malformations and tumors beyond childhood: what general radiologists need to know. Radiol Clin North Am. 58(3):583-601, 2020
                                                                          2. Hussein A et al: Imaging of vascular malformations. Radiol Clin North Am. 58(4):815-30, 2020
                                                                          3. Pimpalwar S: Vascular malformations: approach by an interventional radiologist. Semin Plast Surg. 28(2):91-103, 2014
                                                                          4. Behr GG et al: Vascular anomalies: hemangiomas and beyond--part 1, fast-flow lesions. AJR Am J Roentgenol. 200(2):414-22, 2013
                                                                          5. Behr GG et al: Vascular anomalies: hemangiomas and beyond--part 2, slow-flow lesions. AJR Am J Roentgenol. 200(2):423-36, 2013
                                                                          6. Flors L et al: MR imaging of soft-tissue vascular malformations: diagnosis, classification, and therapy follow-up. Radiographics. 31(5):1321-40; discussion 1340-1, 2011
                                                                          7. Navarro OM et al: Pediatric soft-tissue tumors and pseudotumors: MR imaging features with pathologic correlation: part 1. Imaging approach, pseudotumors, vascular lesions, and adipocytic tumors. Radiographics. 29(3):887-906, 2009
                                                                          8. Weiss SW et al: Benign tumors and tumor-like lesions of blood vessels. In Weiss SW et al: Enzinger and Weiss' Soft Tissue Tumors. 5th ed. Elsevier. 633-64, 2008
                                                                          9. Calonje E: Haemangiomas. In Fletcher CDM et al: World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of Soft Tissue and Bone. IARC Press. 156-8, 2002