Vascular Malformation Involving the Brachial Plexus: A Case Report and Review of Literature

Abstract

Introduction: Vascular anomalies, comprising up to 4.5% of the general population, are aberrations occurring during vascular development. Vascular abnormalities are frequently identified in children and frequently exhibit characteristics similar to nerve sheath tumors. We report a case of 16 years old boy with a arterio-venous (AV) malformation (AVM) affecting the brachial plexus. We discuss the clinical features, diagnosis, treatment, and histopathological findings in this patient and review the relevant literature.

Case report: A 16- year-s old boy presented with pain, paresthesia, swelling, and reduced grip strength of the hand. Radiological investigations revealed a vascular lesion encasing C5, C6 nerve roots and displacing the C7 root. Near total surgical excision of the lesion was done with preservation of nerve. Histopathology confirmed arteriovenous AVMmalformation with distinct features.

Conclusion: High-resolution ultrasound is crucial for diagnosing soft- tissue vascular anomalies. Surgeons well versed in micro surgical skill play a vital key role in minimizing neural deficits. In the case of vascular malformations of brachial plexus, near total excision is the most favorable option.

Keywords: Vascular anomalies; arterio-venous malformation (AVM); brachial plexus.

Figure 1

Ultra-sonography findings: High-resolution ultra-sonography of neck showing a well-defined, lobulated, vascular lesion between anterior and middle scalene muscles, involving C5, C6 roots and displacing C7 roots.

Figure 2

Pre-operative workup: Incision marking over posterior triangle.

Figure 3

Intraoperative pathology: Intraoperative picture showing isolated vascular lesion.

Figure 4

Post-operative finding (under microscope). Histology was reported as arteriovenous malformation. Showing fibrocollagenous tissue and fibrofatty tissue with admixture of blood vessels consisting of capillaries, arteries, and venules.