Vascular Lesions in Childhood - What You See Is Not Always What You Get

Case Report

J Fam Med. 2019; 6(4): 1175.

Vascular Lesions in Childhood - What You See Is Not Always What You Get

Maqsood S¹, Watson C²*, Decade E¹ and Guiney P¹

¹Department of Family Medicine, Nassau University Medical Center, USA

²American University of the Caribbean School of Medicine, USA

*Corresponding author: Watson C, 2201 Hempstead Turnpike, East Meadow, New York 11554, USA

Received: March 19, 2019; Accepted: April 25, 2019; Published: May 02, 2019


We report a case of a 9-year-old boy who presented with a non-tender, progressively growing mass on his right flank that was not present at birth. After imaging studies were conducted the patient was diagnosed and treated for an extracranial arteriovenous malformation (AVM). The patient was referred to the pediatric and plastic surgical services for surgical removal of the lesion. A literature review was conducted to look at the diversity of vascular lesions and resultant clinical sequelae in children. Findings suggest that magnetic resonance imaging along with other imaging modalities is critical for unique presentations of AVMs, in order to dictate subsequent management, future prognosis, and prevent potential life-threatening sequelae.

Keywords: Hemangioma; Arteriovenous malformations; Blood vessels; Neoplasms


Vascular lesions of infancy are common and are divided into two categories – hemangiomas and malformations [1,2]. Infantile hemangiomas (IHs) are considered to be the most common vascular tumors of infancy [1-4]. IHs typically present within the first few days to months of life, and experience a rapid growth phase with 70% of the lesions undergoing complete involution by the age of seven [2,5]. Malformations, more so arteriovenous malformations (AVMs), are products of morphogenesis errors and subsequent vascular channel abnormalities [1]. AVMs are typically present at birth, undergo a rapid proliferative phase, and demonstrate no tendency for spontaneous involution, thus raising concern for clinical sequelae [1,6]. Due to the far less prevalent nature of AVMs, they are frequently misdiagnosed in early life [6]. We report a case of a 9-yearold boy with a progressively enlarging right flank mass presenting with clinical features of both an AVM and IH. To our knowledge, there have not been previously reported cases of undefined vascular lesions in the post-infancy period.

Case Presentation

A 9-year-old male with no significant past medical history presented to the primary care clinic for a well-child visit. The patient had emigrated from Ecuador and denied any acute complaints or concerns. Physical examination was unremarkable apart from the examination of the flank, which demonstrated a large mass on the right posterolateral aspect (Figure A and Figure B). The mass was warm, erythematous and non-tender to palpation.

According to the parents, there was no presence of a mass or vascular lesion at birth. The presenting mass developed when the patient was a few months of age and continued to grow without any regression. Imaging, nor a biopsy was ever performed, and the parents were informed that the mass would likely continue to grow.

At our facility, the patient underwent imaging studies to further evaluate the lesion. Magnetic resonance imaging (MRI) with and without contrast was performed and demonstrated a 6.6 x 10.5 x 11.2 mass centered within the subcutaneous tissues along the lateral aspect of the right lower rib cage (Figure C). This mass consisted of a large area of fatty proliferation with numerous blood vessels extending throughout the lesion. On contrasted imaging, there were several large arterial blood vessels seen supplying this lesion. There were also multiple venous structures seen draining the lesions and extending along the course of the dilated arterial structures; findings consistent with a high flow vascular malformation. He was referred to the pediatric and plastic surgical services for further evaluation.