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Surgery for Congenital Arterial, Venous, and Lymphatic Anomalies Workup

  • Author: Jaime Shalkow, MD, FACS; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
Updated: Jul 08, 2016

Laboratory Studies

The workup of vascular anomalies relies heavily on history, physical examination, and overall clinical assessment. Typically, laboratories studies are not required in the workup and diagnosis of these anomalies. However, in patients with multiple venous malformations, Kasabach-Merritt syndrome, and combined malformations, coagulation studies are warranted because coagulopathies are often present.


Imaging Studies


Most hemangiomas can be managed without imaging studies. However, magnetic resonance imaging (MRI) is warranted in the following circumstances:

  • Lesions consistent with PHACE syndrome (posterior fossa malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye anomalies) should undergo imaging to evaluate the carotids and cerebral vasculature
  • The presence of multiple cutaneous lesions warrants screening with ultrasonography or MRI to assess concomitant visceral lesions
  • Lumbosacral lesions require imaging of the spinal cord (ultrasonography or MRI) to rule out synchronous cord lesions
  • Preoperative imaging may be required at the discretion of the surgeon

Venous malformations

MRI or venography may be required to delineate the full extent of complex venous malformations. Such information may be useful for assisting in treatment and operative management.

Capillary malformations

Imaging of the spinal cord should be considered in the presence of capillary malformations; developmental defects of the central neural axis are common with these lesions.

Lymphatic malformations

Large lymphatic malformations may be diagnosed in utero with ultrasonography.[31] Such malformations are classified according to their radiographic and histologic characteristics. Hence, multimodality imaging is often used for proper delineation. MRI and Doppler ultrasonography yield insight into the extent and flow characteristics, respectively.

Arteriovenous malformations

Ultrasonography with Doppler imaging is a very useful tool to confirm the diagnosis of suspected arteriovenous malformation (AVM). Further imaging with MRI can delineate the full extent of the lesion and involvement of other structures. Angiography may also be useful to aid in embolization and preoperative planning. Hardwicke et al described a case in which office-based thermography was used adjunctively in the assessment of an AVM of the hand.[41]

Contributor Information and Disclosures

Jaime Shalkow, MD, FACS Director, National Pediatric Cancer Program, National Center for Pediatric and Adolescent Health (CeNSIA); Attending Pediatric Surgical Oncologist, Cancer Center at the American British Cowdray Medical Center

Jaime Shalkow, MD, FACS is a member of the following medical societies: American College of Surgeons, International Society of Paediatric Surgical Oncology, Pacific Association of Pediatric Surgery, Mexican Association of Pediatric Surgery, Mexican Society of Oncology, Mexican Association of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Jonah Odim, MD, PhD, MBA Section Chief of Clinical Transplantation, Transplantation Branch, Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH)

Jonah Odim, MD, PhD, MBA is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American Association for Physician Leadership, American College of Surgeons, American Heart Association, American Society for Artificial Internal Organs, American Society of Transplant Surgeons, Association for Academic Surgery, Association for Surgical Education, International Society for Heart and Lung Transplantation, National Medical Association, New York Academy of Sciences, Royal College of Physicians and Surgeons of Canada, Society of Critical Care Medicine, Society of Thoracic Surgeons, Canadian Cardiovascular Society

Disclosure: Nothing to disclose.

Chief Editor

Mary C Mancini, MD, PhD, MMM Professor and Chief of Cardiothoracic Surgery, Department of Surgery, Louisiana State University School of Medicine in Shreveport

Mary C Mancini, MD, PhD, MMM is a member of the following medical societies: American Association for Thoracic Surgery, American College of Surgeons, American Surgical Association, Society of Thoracic Surgeons, Phi Beta Kappa

Disclosure: Nothing to disclose.


Jeff L Myers, MD, PhD Chief, Pediatric and Congenital Cardiac Surgery, Department of Surgery, Massachusetts General Hospital; Associate Professor of Surgery, Harvard Medical School

Jeff L Myers, MD, PhD is a member of the following medical societies: American College of Surgeons, American Heart Association, and International Society for Heart and Lung Transplantation

Disclosure: Nothing to disclose.

Ahmad Y Sheikh, MD Resident Physician, Department of General Surgery, Massachusetts General Hospital

Ahmad Y Sheikh, MD is a member of the following medical societies: American College of Surgeons and American Heart Association

Disclosure: Nothing to disclose.

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