Venous Malformations Workup

Updated: Jun 13, 2019
  • Author: Silvio Podda, MD; Chief Editor: Gregory Gary Caputy, MD, PhD, FICS  more...
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Workup

Laboratory Studies

Typically, no laboratory tests are indicated for cutaneous venous malformations. Clotting studies and a CBC may be indicated in an occasional visceral lesion that is bleeding. If a particular anomaly is a diagnostic dilemma, urinary bFGF analysis rarely may be indicated as part of the workup.

A 2005 study was able to differentiate between proliferating hemangiomas and vascular malformations based on serum vascular endothelial growth factor (VEGF) levels. [7]

Perform a coagulation profile on children with extensive disease, as there is a risk for low-grade, localized intravascular coagulopathy (LIC). Disseminated intravascular coagulopathy (DIC) is rare.

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Imaging Studies

Imaging studies include the following:

  • Plain radiographs - Phleboliths pathognomonic

  • MRI

    • Most informative modality

    • Hyperintense on T2-weighted images [5]

    • No flow voids

    • Inhomogeneous contrast enhancement (like CT)

  • Computed tomography (CT) scans

    • Inhomogeneous contrast enhancement (like MRI)

    • Phleboliths easily seen

  • Ultrasonography - Hypoechogenic, septated mass

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Diagnostic Procedures

Arteriography has little or no role in venous malformation unless the diagnosis is unclear.

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Histologic Findings

If the diagnosis is in doubt, biopsy the lesion. Most venous malformations are diagnosed based on a good history and physical examination; all of the above studies are ancillary.

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