Author(s)

Camenzuli A, Klafkowski G, Yeong C, Attard A.

Patient

male, 30 year(s)

A patient with a two week history of right calf pain was referred for a lower limb venogram to exclude deep vein thrombosis.

A patient with a two-week history of calf pain was referred for a right lower limb venogram. He had no chest pain and was not dyspnoeic. There was no relevant past history. He was non-smoker and worked as a chemical engineer.

On examination, two small irregular areas of blue/purple discolouration were seen. One of these lesions was present diffusely around the dorsum of the toes and the other over the medial malleolus of the right leg. The foot was warm and there was no oedema. There was no evidence of deep vein thrombosis.

Venous malformations are developmental anomalies and are a type of low flow vascular malformation. They have a variable clinical presentation that depends on their extent and depth (1). Most lesions consist of masses of sinusoidal spaces that have varying communications with varying veins. Others consist of varicosities or dysplasias of small or large vessels. Phleboliths may be evident on plain radiographs or computerised tomography.

Most venous malformations are symptomatic with swelling and pain. The overlying skin may have a blue or purple discolouration. Venography or doppler ultrasound may confirm the diagnosis, however magnetic resonance imaging (MRI) better defines the extent of the abnormality. On MRI the abnormality is seen as focal or diffuse areas of high signal on T2-weighted images, often containing separate spaces. Diffuse lesions of the lower extremities can cause haemarthrosis and an arthropathy; these are best demonstrated using MR venography (2). Interventional techniques such as intralesional sclerotherapy may play an important role in their management. Treatment with direct injection of absolute ethanol after venography is effective and results in thrombosis and involution(3).