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Hirschprung Disease
Joseph Junewick, MD FACR
over 5 years ago
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Developmental Venous Anomaly

Case Detail

Anatomy: Brain-Spine
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Developmental or Congenital
Created: over 6 years ago
Updated: over 6 years ago
Tags: PEDS
Modality/Study Types: MR
Activities:
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History

Teenager with headache.


Case Images


Diagnosis

Developmental Venous Anomaly

Discussion

Developmental venous anomalies (DVA) represent extreme variations of the normal transcerebral venous system. DVAs are asymptomatic in most cases; occasionally venous ischemia or infarctions may occur if the outflow is compromised. DVAs are believed to be adaptations from occlusion or maldevelopment of either the superficial or deep veins during development, resulting in establishment of collateral drainage pathways.

At CT and MR imaging, the main draining vein can be identified as a linear or curvilinear enhancing structure or flow void. Enhancement of the dilated medullary veins (“caput medusae”) can also be observed. The classic angiographic feature is the caput medusae (or “inverse umbrella”) appearance of the transmedullary veins seen only in the venous phase. A dense capillary stain can be seen in larger lesions; however, the lack of arterial enlargement suggests a DVA.

Occasionally, signal abnormalities may be seen adjacent to DVAs on standard MR sequences. The etiology of the signal intensity is uncertain but may be related to edema or gliosis related to venous stenosis or altered hemodynamics. Ischemic or demyelinating disease in the drainage area of the DVA may also contribute.

Reference

Geibprasert S, Pongpech S, Jiarakongmun P Shroff MM, et al. Radiologic Assessment of Brain Arteriovenous Malformations: What Clinicians Need to Know. Radiographics (2010); 30: 483-501.

Santuccia GM, Leacha JL, Yingd J, Tomisicka TA. Brain Parenchymal Signal Abnormalities Associated with Developmental Venous , Anomalies: Detailed MR Imaging Assessment. American Journal of Neuroradiology (2008); 29:1317-1323.



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