Venous vascular malformations and compressive neuropathy

Abstract

Background: Venous malformations (VMs) are slow flowing congenital vascular malformations that demonstrate continuous growth. They are prone to bleeding and frequent invasion of adjacent structures. It is therefore important to differentiate them from schwannomas, which can appear similar on imaging. Currently, the literature demonstrates only a few examples of pathology misdiagnosed as a schwannoma, and of VMs associated with neurological deficits. We will illustrate the characteristics and management of VMs causing compressive neuropathy in the cervical and upper extremity regions and contrast them against the features of peripheral nerve sheath tumors. Case description: Two case reports are presented, one of a 55-year-old woman with a chronic cervical mass due to a venous malformation (VM) originally misdiagnosed as a schwannoma, and another of a 35-year-old man with a vascular malformation of predominantly venous pathology in the antecubital fossa. Both patients were surgically managed. Conclusions: Patients presented with chronic pain, weakness and paresthesia. Venous malformations were seen as thinly encapsulated, multilobular, heterogeneously enhancing lesions with internal fluid levels and venous lakes. Post-contrast septate enhancement, intrinsic foci of T1 hyperintensity, phleboliths, T2 hyperintensity, and nodular enhancement of torturous vessels we also noted. MEP, SSEP, and EMG monitoring was used during surgical resection. Both patients had favorable outcomes. Keywords: Venous, Malformation, Schwannoma, Antecubital, Cervical, Mass, Misdiagnosis