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Angiolymphatic Malformation
Joseph Junewick, MD FACR
over 8 years ago
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Paraspinal Venous Malformation

Case Detail

Anatomy: Brain-Spine
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Neoplasia Benign
Created: over 7 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: MR
Activities:
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History

2 year old with history of fall. Rule out spinal injury.


Case Images


Diagnosis

Paraspinal Venous Malformation

Clinical Notes

CT of the brain revealed a non-displaced right parietal skull fracture and small subdural hematoma.

Findings

MR – Variably enhancing, minimally T1 hyperintense and markedly T2 hyperintense left paraspinal lesion insinuating into neural foramina and the intraspinal extradural space.

Discussion

A hemangioma is a abnormal congenital collection of blood vessels which may be found in one or several organs (skin, lungs, GI tract, eyes, and brain). However these benign, vascular neoplasms make up less than 0.5% of all mediastinal masses. Like other mediastinal masses of childhood, these might manifest by nonspecific symptoms (cough, dyspnea and chest pain) or symptoms related to their anatomic location and extent of invasion but most often, they are asymptomatic and are incidentally detected. The vast majority of mediastinal hemangiomas are located in the anterior mediastinum (68%). The posterior mediastinal location is very rare. Involvement of the middle mediastinum is seen as a continuation of disease from anterior or posterior locations.

Most of the posterior mediastinal tumors in children are of neurogenic origin (neurofibroma, neurilemoma, neurenteric cyst, neuroblastoma, ganglioneuroblastoma, pheochromocytoma and neurofibrosarcoma). A posterior mediastinal mass in a young child is most often of neurogenic origin, with neuroblastoma being the diagnosis of import.

The avid enhancement of a hemangioma mitigates against thoracic neuroblastoma, which typically enhances much less. The identification of metastatic disease suggests neuroblastoma; however, metastases are less common with thoracic neuroblastoma. Lack of calcification is not helpful in narrowing the diagnosis, since hemangiomas and thoracic neuroblastomas often lack calcification. Some neurogenic tumors, namely pheochromocytomas and paragangliomas, might demonstrate MR characteristics similar to those of a hemangioma—hypointense on T1 weighted images and very hyperintense on T2-weighted images.

Reference

Sabharwal GK, Strouse PJ. Posterior mediastinal hemangiomas. Pediatr Radiol (2005); 35:1263-1266.



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