EURORAD ESR

Case 14433

Upper limb AVF with combined soft tissue and osseous involvement

Author(s)
Emad Moussa.FRCR//MD. Dr Khaled ABDEL AAL, MD FSCV (France)

Mediclinic Airport hospital; Abudhabi, United Arab Emirates; Email:memad@mediclinic.ae
 
Patient
female, 14 year(s)
 
 
  • Figure 1
    CT Angiography
     

    VR CT angiography with extensive dilated arteries and veins with multiple sites of anomalous communications

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Congenital;

    MIP CT with humeral osseous deformity and altered appearance of the medullary cavity

     
    Area of Interest: Vascular; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Congenital;

    MPR CT with prominent subclavian artery and vein draining extensive limb AVF

     
    Area of Interest: Vascular; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Congenital;

    MIP CT with extensive hypertrophy of the nutrient arteries grooves at the metaphysis with further transformation of the whole medullary cavity of humerus to an enhancing large vascular space .

     
    Area of Interest: Vascular; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Congenital;

    MPR CT with huge nutrient artery at the distal radius and vascularization of the radial medullary cavity

     
    Area of Interest: Vascular; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Congenital;

    Metacarpal head involvement

     
    Area of Interest: Vascular; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Congenital;

    Colour coded arterial phase MPR comparing between the abnormal right Radius (A) and normal left side (B). The abnormal side demonstrates extensive vascularization of the medullary space (Arrow in A)

     
    Area of Interest: Vascular; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Congenital;
     
     
  • Figure 2
    Conventional Angiography
     

    conventional angiography demonstrates smoky pattern enhancment of the medullary spaces of bones (Arrows)

     
    Area of Interest: Vascular; Imaging Technique: Catheter arteriography; Procedure: Diagnostic procedure; Special Focus: Congenital;

    conventional angiography with faint aneurysmally dilated nutrient artery at the proximal humerus (Arrow)

     
    Area of Interest: Vascular; Imaging Technique: Catheter arteriography; Procedure: Diagnostic procedure; Special Focus: Congenital;
     
     
  • Figure 3
    MRI CARDIAC
     

    Axial T1 with signal void pattern seen at the medullary space of the humerus sequel to high flow intra osseous vasculature (Arrow)

     
    Area of Interest: Vascular; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Congenital;

    Cardiac MRI with dilated both right and left ventricles

     
    Area of Interest: Vascular; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Congenital;

    Cardiac functional scan with significant rise of the cardiac output and manifest ventricle dilatation

     
    Area of Interest: Vascular; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Congenital;
     
     
VR CT angiography with extensive dilated arteries and veins with multiple sites of anomalous communications
 
MIP CT with humeral osseous deformity and altered appearance of the medullary cavity
 
MPR CT with prominent subclavian artery and vein draining extensive limb AVF
 
MIP CT with extensive hypertrophy of the nutrient arteries grooves at the metaphysis with further transformation of the whole medullary cavity of humerus to an enhancing large vascular space .
 
MPR CT with huge nutrient artery at the distal radius and vascularization of the radial medullary cavity
 
Metacarpal head involvement
 
Colour coded arterial phase MPR comparing between the abnormal right Radius (A) and normal left side (B). The abnormal side demonstrates extensive vascularization of the medullary space (Arrow in A)
 
conventional angiography demonstrates smoky pattern enhancment of the medullary spaces of bones (Arrows)
 
conventional angiography with faint aneurysmally dilated nutrient artery at the proximal humerus (Arrow)
 
Axial T1 with signal void pattern seen at the medullary space of the humerus sequel to high flow intra osseous vasculature (Arrow)
 
Cardiac MRI with dilated both right and left ventricles
 
Cardiac functional scan with significant rise of the cardiac output and manifest ventricle dilatation
 
 
 
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