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SonoPhile

A 17 year-old diagnosed with a case of abdominal wall arteriovenous malformation (AVM) . Vascular anomalies include vascular tumors (VT) and vascular malformations (VM). VTs are categorized by clinical behavior, while VMs are classified by flow characteristics, histopathology, and associations with other anomalies. Sonography is the primary diagnostic tool for assessing abdominal wall disorders and masses, playing a crucial role in diagnosing and monitoring abdominal wall VMs. 

Sonography of abdominal wall vascular malformation

  • Patient: 17-year-old female presented with painless lower abdominal wall swelling.

  • Physical Examination: Large non-mobile mass in left hypogastric region with parenchymatous consistency.

  • Ultrasound (US) Examination:

    • Oval morphology with lobulated margins.

    • Nonhomogeneous internal echo-structure.

    • Located below subcutaneous tissue, protruding towards anterior bladder wall without infiltration.

    • Intense intralesional vascularization with hypertrophic artery observed on color-power Doppler.

  • Magnetic Resonance Angiography (MRA):

    • Confirmed voluminous expansive mass (craniocaudal diameter: 14.07 cm; anteroposterior diameter: 5.13 cm).

    • Hyperintensity on T2-weighted sequences, isointensity on T1 sequences.

    • Intense and nonhomogeneous contrast enhancement.

    • Fed by left inferior epigastric artery; protruded into abdominal cavity with close anatomical relations to bladder, uterine fundus, and sigma.

  • Magnetic Resonance Angiography (MRA):

    • Confirmed voluminous expansive mass (craniocaudal diameter: 14.07 cm; anteroposterior diameter: 5.13 cm).

    • Hyperintensity on T2-weighted sequences, isointensity on T1 sequences.

    • Intense and nonhomogeneous contrast enhancement.

    • Fed by left inferior epigastric artery; protruded into abdominal cavity with close anatomical relations to bladder, uterine fundus, and sigma.

  • Diagnosis: Intramuscular arteriovenous malformation (AVM) confirmed by histological evaluation after US-guided excisional biopsy.

  • Treatment Approach: Serial embolizations and strict ultrasonographic follow-up due to size, complex position, and asymptomatic nature.

  • Outcome: After four years, mass slightly reduced in size (craniocaudal diameter: 9.72 cm; anteroposterior diameter: 4.16 cm), with decreased intralesional flows and perfusion observed on color-power Doppler analysis.

Conclusion

  • Diagnostic Approach:

    • Sonography used as first-line diagnostic tool for evaluating abdominal wall masses.

    • Safe, portable, and avoids ionizing radiation exposure.

    • Color Doppler US provides crucial flow signal information for initial diagnosis.

  • Follow-Up and Monitoring:

    • Sonography, color-power Doppler analysis, and panoramic imaging are effective for VMs follow-up.

    • They provide valuable clinical tools for monitoring disease progression and treatment efficacy.

Credit to: Cocco, G., Ricci, V., Cocco, N., Boccatonda, A., D'Ardes, D., Basilico, R., & Schiavone, C. (2020). Sonography of abdominal wall vascular malformation: a case report and review of the literature. Journal of ultrasound, 23(4), 481–485. https://doi.org/10.1007/s40477-020-00523-1

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