Vascular lesions of the head and neck: an update on classification and imaging review

Brahmbhatt, Akshaar N.; Skalski, Kamila A.; Bhatt, Alok A.

doi:10.1186/s13244-019-0818-3

Insights into Imaging

Table 2 Characteristics of vascular malformations

From: Vascular lesions of the head and neck: an update on classification and imaging review

Vascular Malformations	Presentation	MR Imaging Characteristics	Additional helpful imaging characteristics
Capillary	Cutaneous lesions that often follow a dermal pattern.	Limited utility of imaging.
		Can be used to exclude complicating components not obvious on physical exam.
		Additional imaging can be performed if a syndrome is suspected.
Macrocystic Lymphatic	Present at birth or by two years of age.	Complex multiloculated cystic mass with fluid-fluid levels. Cysts typically larger than > 2 cm. Enhancement of the walls and septa on post contrast imaging.	US: large cystic structures without internal vascularity.
Macrocystic Lymphatic	Soft large translucent non tender mass.		US: large cystic structures without internal vascularity.
Microcystic Lymphatic	Present at birth or by two years of age. Grow slowly in proportion to growing child.	Transpatial T1 hypointense T2 hyperintense lesion with multiple small cysts typically less than 2cm. No enhancement.
Microcystic Lymphatic	May appear as several small, raised sacs on the skin.
Venous	Most common type of vascular malformation. Slow flow vascular malformation presents as a non pulsatile compressible soft tissue prominence or discrete mass typically with blueish-purple hue.	T2 hyperintense serpiginous tubules that enhance on delayed phase.	CT: serpiginous lesions that enhance on post contrast imaging. More sensitive for phlebolith identification.
Venous	Often tracking along muscle groups or nerves. These are responsive to changes in flow i.e. Valsalva.	T2 hypointense focal phleboliths.
Venolymphatic	Present with characteristics of both lymphatic and venous malformation.	Multiloculated cystic mass with fluid-fluid levels. Some enhancement on delayed phase images. Phleboliths can be present.	CT: serpiginous lesions, some areas can enhance on post contrast imaging. More sensitive for phlebolith identification.
Venolymphatic	Classically soft nontender mass can have a blueish-purple hue.
AVM	Can present with CHF, embolism, pain, or bleeding depending on location.	Serpiginous tangle of vessels with enhancement on post contrast imaging and early enhancement of the draining veins.	DSA remains the gold standard.
AVM	High flow vascular malformation can present with pulsating lesion or thrill on examination. May feel warm on palpation.		Serpiginous tangle or mass of vessels with enhancement on post contrast imaging and early enhancement of the enlarged draining veins.
AVF	Symptoms depend on location and what vessels are involved. Can be asymptomatic and incidentally found.	Abnormal connection between an artery and vein, may present as abnormal dilation and fistulous tract on post contrast imaging.	DSA remains the gold standard and demonstrates direct communication of an artery with an abnormal early filling draining vein.
AVF	Increased collateralization commonly seen.	Best seen on MRA which demonstrates abnormal early venous enhancement.

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