Contributed by
Hackensack Meridian School of Medicine
Anirudh Maddali, and Rajiv Biswal.
History
A 16 year old female presented with a symptomatic right triceps intramuscular vascular malformation. MRI demonstrated a 2.4 x 3.1 x 5.1 cm predominantly T2 hyperintense, mildly T1 hyperintense, heterogeneous enhancing mass at the mid-to-distal triceps muscle, with focal T2 hypointense areas suggestive of phleboliths. Under ultrasound guidance with a tourniquet applied to the right upper extremity proximal to the lesion, venous access was obtained, and contrast injection confirmed filling of the nidus without rapid outflow. The lesion was successfully treated with percutaneous sclerotherapy using a mixture of sodium tetradecyl sulfate (STS), lipiodol, and air. Post-intervention imaging demonstrated decreased conspicuity of the lesion with avascular ovoid regions consistent with treatment effect.
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Question
Which imaging finding most strongly supports the diagnosis of a low-flow venous malformation rather than a high-flow vascular lesion?
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