Patients with intralesional hemorrhage in venous malformations: diagnosis and embolosclerotherapy

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: 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.