Chen Hui, Lin Xiaoxi, Jin Yunbo, Li Wei, Ma Gang, Hu Xiaojie
Shanghai Ninth People's Hospital, Shanghai, China.
J Vasc Surg. 2009 Feb;49(2):429-33; discussion 433-4. doi: 10.1016/j.jvs.2008.08.051. Epub 2008 Oct 22.
Venous malformations (VMs) are common congenital benign lesions characterized by slow progression. However, intralesional hemorrhage can result in sudden enlargement of the lesions, which, though uncommon clinically, brings difficulties in diagnosis and treatment. The purpose of this study is to explore the clinical features and diagnosis modality of intralesional hemorrhage in VMs and present our experience with embolosclerotherapy.
A series of 16 patients were recruited from May 2003 to February 2007, of which fifteen were males and one was female, aged from five months to 40 years (mean, 11.4 years). The anatomic sites affected included cheek (n = 6), upper lid (n = 3), neck (n = 3), parotid region (n = 2), temple (n = 1), and upper limb (n = 1). The period of enlargement varied from one day to 25 days (mean, 8.4 days). Diagnostic needle aspiration was performed to analyze the internal contents of the masses by macroscopic observation. Magnetic resonance imaging (MRI) was applied to determine the size, location, and extent of the lesions. Two patients received percutaneous venography. Routine blood testing was carried out in all cases. A combination of absolute alcohol and Bleomycin A5 embolosclerotherapy was administered to the patients. The procedure was repeated after 6 to 8 weeks. Outcomes were assessed by MRI measurement and pre and post treatment color photos.
All the patients were diagnosed with hemorrhage in VMs. The volume of the localized lesions varied from 3 cm x 2 cm x 1 cm to 8 cm x 5 cm x 3 cm. Fourteen patients received embolosclerotherapy in one (n = 10) or two (n = 4) sessions. Two cases were not treated and the lesions regressed spontaneously with detectable residual lesions. After a mean follow-up of 25 months (range, 3 to 40 months), treatment was considered effective in 12 patients. The complications were minimal including temporary swelling in 14 treated patients and mild fever in two patients.
Intralesional hemorrhage in VMs should be distinguished from other lesions in the head and neck region. Diagnostic puncture and MRI are essential for accurate diagnosis. Percutaneous embolosclerotherapy using a combination of absolute ethanol and Bleomycin A5 is a safe and effective treatment of choice.
静脉畸形（VMs）是常见的先天性良性病变，其特点是进展缓慢。然而，病灶内出血可导致病变突然增大，尽管临床上并不常见，但给诊断和治疗带来困难。本研究的目的是探讨VMs病灶内出血的临床特征和诊断方法，并介绍我们在栓塞硬化治疗方面的经验。
2003年5月至2007年2月共纳入16例患者，其中男性15例，女性1例，年龄从5个月至40岁（平均11.4岁）。受累的解剖部位包括脸颊（n = 6）、上眼睑（n = 3）、颈部（n = 3）、腮腺区（n = 2）、颞部（n = 1）和上肢（n = 1）。增大期从1天至25天不等（平均8.4天）。进行诊断性针吸，通过肉眼观察分析肿块的内部成分。应用磁共振成像（MRI）确定病变的大小、位置和范围。2例患者接受了经皮静脉造影。所有病例均进行了常规血液检查。对患者采用无水乙醇和博来霉素A5联合栓塞硬化治疗。6至8周后重复该操作。通过MRI测量以及治疗前后的彩色照片评估疗效。
所有患者均诊断为VMs病灶内出血。局限性病变的体积从3 cm×2 cm×1 cm至8 cm×5 cm×3 cm不等。14例患者接受了1次（n = 10）或2次（n = 4）栓塞硬化治疗。2例未接受治疗，病变自发消退，有可检测到的残留病灶。平均随访25个月（范围3至40个月）后，12例患者的治疗被认为有效。并发症极少，14例接受治疗的患者出现暂时性肿胀，2例患者出现低热。
VMs病灶内出血应与头颈部其他病变相鉴别。诊断性穿刺和MRI对于准确诊断至关重要。使用无水乙醇和博来霉素A5联合进行经皮栓塞硬化治疗是一种安全有效的治疗选择。
