Venous Malformations Workup

Updated: Mar 08, 2021
  • Author: Silvio Podda, MD; Chief Editor: Gregory Gary Caputy, MD, PhD, FICS  more...
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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.


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


Diagnostic Procedures

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


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.