Ultrasound examination of venous malformation

Ultrasound examination of venous malformation

REVIEWED BY Katrina Dietrich | ASA SIG: Vascular

REFERENCE | Authors: H Kim & N Labropoulos

WHY THE STUDY WAS PERFORMED

The authors discuss venous malformations (VM) and present an ultrasound protocol for performing a malformation study. As VM can be complex and extensive, Kim and Labropoulos successfully simplify and break down the topic for experienced vascular sonographers. The authors stress the importance of differentiating between varicose veins (VV) and VM to appropriately guide management. Other imaging modalities are briefly mentioned, highlighting the typical US limitations – operator dependency and anatomy complexity.

HOW THE STUDY WAS PERFORMED

Kim & Labropoulos review case studies from patients diagnosed with venous malformations and discuss the ultrasonic features of several examinations. The authors include clinical as well as ultrasonic images, focusing on specific imaging features indicative of venous malformations. The article presents several differing malformations (size, location, depth, anatomical relationships) with similar ultrasonic findings assisting in the arrival of a VM diagnosis. Other imaging modalities were also discussed.

The natural history and prognosis of VVs and VM are different, and the discrimination of both diseases is critical for devising management strategies.

WHAT THE STUDY FOUND

The article presents a case in the utility of ultrasound to differentiate between VM and VV, which has clinical implications for patient management. The clinical cases discussed further demonstrate the importance of ultrasound in conjunction with other imaging modalities for diagnosing and characterising venous malformations. Specific ultrasonic features such as low to very low flow, minimal reflux (if present), as well as the presence of muscular or bony involvement, are indicative of venous malformations. Importantly, the identification of phleboliths within the vascular structures is another definitive feature.

The authors found that ultrasound can delineate the extent and anatomical characteristics of venous malformations in many cases, aiding in treatment planning and decision-making. Furthermore, the study discussed the advantages of ultrasound over other imaging modalities in terms of accessibility, cost-effectiveness, and real-time evaluation. Despite its limitations in visualising deeper structures compared to MRI or CT scans, ultrasound is a valuable initial imaging tool due to its non-invasive nature and ability to provide dynamic imaging, allowing for the assessment of hemodynamic changes within the malformation.

RELEVANCE TO CLINICAL PRACTICE

This article serves as an important reminder to the reader that the most common type of congenital vascular malformations is venous malformations. Ultrasound can be a reliable imaging modality for the diagnosis and characterisation of VM, which is crucial for guiding treatment strategies. This article briefly discusses the pathogenesis of VM, provides a protocol for ultrasound examination as well as presents ultrasonic imaging findings of clinical cases. The authors provide a list of distinguishing features comparing VM and VV, which is helpful for vascular sonographers who will be exposed to VM.

Vascular ultrasound is useful in diagnosing and characterising these malformations, allowing for prompt and accurate diagnosis, facilitating early intervention and appropriate management planning. The accessibility and cost-effectiveness of ultrasound make it a practical first-line imaging modality in assessing patients with suspected venous malformations. Real-time imaging and dynamic assessment of blood flow within the malformation assist clinicians in monitoring changes over time and evaluating treatment response. US avoids exposure to the articular in the younger patient cohort.