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Arteriovenous Malformations are complex and challenging entities, and their treatment is often tailored on the patient. Interstitial sclerosing treatment with bleomycin is promising especially in cases where the aesthetical and/or functional burden of surgical intervention would be impactful as in the S3 AVM according to the SECg classification. We treated 15 patients presenting small (<10cm3) S3 arterio-venous malformations with 3 + 3 sessions of 15.000 IU of interstitial bleomycin. 9 patients presented moderate to good response to the first 3 sessions and thus surgical re-shaping was performed between the two cycles. US examination was done pre-treatment, before each session and every 3 months after the end of the protocol to assess the arterio-venous malformations. Fifteen of the seventeen patients concluded the protocol. 9 patients underwent surgical re-shaping while 6 skipped it because of their excellent response to the first 3 bleomycin injections. Major improvement in terms of appearance and symptoms (pulsations, ulcerations, bleeding or pain) were always achieved. There was a 20% of minor complications. The presented data are encouraging and seem to suggest that this may be a promising protocol to extend the use of bleomycin in arterio-venous malformations and reduce the impact of surgery. [ABSTRACT FROM AUTHOR]

Sirolimus is being increasingly employed to manage specific vascular anomalies. We performed an exploratory cost‐utility analysis to evaluate sirolimus as a treatment for vascular malformations from the Australian healthcare system perspective. Over a one‐year time horizon, sirolimus treatment was associated with an increased expenditure of AU$2832.80 and a gain of 0.08 quality‐adjusted life years (QALYs) when compared to supportive care, resulting in an incremental cost‐effectiveness ratio of AU$35,410/QALY. By most metrics, sirolimus would be considered a cost‐effective treatment for vascular malformations. [ABSTRACT FROM AUTHOR]

This retrospective study was aimed at characterizing vascular malformations (VMFs) presenting for minimally invasive image-guided therapies (MIT) at a tertiary-care center and evaluating treatment regimens and image-based outcomes using MRI. We analyzed demographic, disease-related, and radiologic features of VMFs presenting to interventional radiology between May 2008 and August 2020 using compendium vascular anomaly (Compva) criteria. MIT and specific agents were evaluated, and treatment effects were assessed through volumetry and mean signal intensity (MSI) on multiparametric longitudinal MRI. The statistics included the paired t-test, ANOVA, and Fisher's exact test. The cohort included 217 patients (mean age 30 ± 18.4 years; 134 female). Venous malformations were most common (47%). VMFs were frequently located in the head-neck region (23.5%), legs (23.04%), and arms (13.8%). Among 112 treatments, sclerotherapy was performed most frequently (63.9%), followed by embolization (19.3%). MRI showed a significant reduction in T2 MSI for venous (1107.95 vs. 465.26; p = 0.028) and decreased contrast media uptake for lymphatic malformations (557.33 vs. 285.33; p = 0.029) after sclerotherapy, while the lesion volumes did not change significantly (p = 0.8). These findings propose MRI-derived MSI as a potential non-invasive biomarker for assessing the response of VMF to MIT. By leveraging MRI, this study addresses challenges in managing rare diseases like VMFs, while advocating for standardized approaches and prospective studies to better link imaging findings with clinical outcomes. [ABSTRACT FROM AUTHOR]

Pediatric dermatologists are frequently consulted to evaluate children for cutaneous signs of systemic disorders. Numerical thresholds of significance have been described in the dermatologic literature for various skin findings where the likelihood of an associated extracutaneous abnormality or known genetic syndrome increases significantly. Knowledge of these numerical thresholds facilitates diagnosis and management, which improves clinical outcomes and avoids severe complications. This review highlights the clinical presentation, complications, evaluation, and numerical significance, when applicable, for the following skin findings: infantile hemangiomas, capillary malformations, café‐au‐lait macules, hypopigmented macules, juvenile xanthogranulomas, pilomatricomas, and angiofibromas. [ABSTRACT FROM AUTHOR]

Kaposiform hemangioendothelioma (KHE) is a rare, aggressive vascular tumor predominantly seen in children. It can infiltrate the deeper soft tissues and is clinically marked by erythematous to violet plaques, sometimes associated with the Kasabach-Merritt phenomenon. A male neonate presented with a substantial mass on the dorsum of his left hand. Surgical excision on the 8th day after birth identified the tumor as KHE, without evidence of Kasabach-Merritt syndrome. Two additional operations were performed over the following year to address contractures and restore finger function. At a 6-month follow-up, the patient showed no significant functional impairment. KHE poses unique clinical challenges due to its aggressive nature. This case highlights the need for prompt surgical intervention, given the tumor's size and location. Managing KHE requires a rapid diagnosis and intervention, particularly in functionally critical areas, to ensure optimal outcomes. [ABSTRACT FROM AUTHOR]

Background Hereditary hemorrhagic telangiectasia (HHT) is a rare genetic disorder that primarily affects the vasculature and exhibits a broad spectrum of clinical manifestations. There is a paucity of detailed literature on its clinical characteristics. Objective This study aims to deepen the understanding of HHT's clinical aspects by documenting the presentations, management, and outcomes of 30 patients diagnosed with the condition, thereby improving recognition and treatment approaches among healthcare professionals. Methods A retrospective review was conducted on 30 HHT cases treated at Peking Union Medical College Hospital from December 2012 to September 2023, focusing on analyzing their clinical features, therapeutic interventions, and follow-up outcomes. Results The study included 8 males and 22 females, with a mean onset age of 20.0 years (range 10.5-34.0 years) and an average disease duration of 19.5 years (range 7.8-26.0 years). Epistaxis was universally present (100.0%), skin and mucosal telangiectasia were noted in 27 patients (90.0%), and 28 (93.3%) exhibited involvement of internal organs, including liver in 24 (80.0%), lungs in 15 (50.0%), gastrointestinal tract in 5 (16.7%), and brain in 3 (10.0%). Additionally, pulmonary hypertension was observed in 17 (56.7%) and iron deficiency anemia in 15 (50.0%). Genetic analysis in 15 patients identified ACVRL1 mutations in 12, ENG mutations in 2, and one patient with both. Beyond routine symptomatic care, some patients underwent targeted medical or interventional treatments, with the majority showing clinical improvement. Conclusion HHT is a systemic disorder affecting multiple organs, with frequent liver and occasional brain involvement. It commonly leads to serious complications such as pulmonary hypertension and iron deficiency anemia. Detailed patient history, thorough examinations, targeted screening of visceral vessels, and genetic testing are essential for early diagnosis and effective management in suspected cases.

Introduction Hemangiomas are benign vascular lesions. The complicated hemangiomas that are causing significant functional or cosmetic problems need surgical excision. This paper presents a novel technique of reconstruction using surgical mesh after removal of a facial hemangioma.Case report A 50-year-old male patient presented with right cheek swelling for more than 40 years causing disproportion of the face. A flap was raised by a nasolabial linear incision, then a 4*2 cm surgical mesh was put in, and the wound closed cosmetically. The excised tissue was sent for histopathological examinations and the results confirmed hemangioma. After more than two years follow up, the patient’s face was symmetrical with normal facial contour.Conclusion The application of surgical mesh for patients who seek functional and cosmetic improvements after hemangioma removal is a constructive method that gives the desired outcome for the patient.

Introduction: This retrospective study aimed to assess the efficacy of bleomycin and sodium tetradecyl sulphate (STS) as sclerotherapeutic treatment modalities for low-flow vascular and lymphatic malformations. A total of 30 patients in age group of 9–60 years with vascular and lymphatic anomalies in the head and neck region were included in our study and divided into two groups of 15 each. Patients in group 1 received bleomycin injections, while group 2 received STS for treatment. They were followed up in records for two years to look for resolution/ relapse/ recurrence of lesions. The no. of injections depended on the lesion size and response after the first and subsequent doses. Results showed that both drugs effectively treated these lesions, with no significant differences in efficacy and safety profiles. However, injection bleomycin had a slightly better cure rate (72%) than STS (61%). Both drugs required similar number of injections to be administered for a similar level of cure. Sclerotherapy provides a precious, non-invasive alternative to surgery in patients with slow-flow vascular and lymphatic anomalies. However, further research is needed to explore potential limitations and avenues for improvement. [ABSTRACT FROM AUTHOR]

This narrative review delves into the intricacies of hemangiomas and vascular malformations (VMs), exploring their characteristics, diagnostic approaches, and therapeutic interventions. Hemangiomas, characterized by an abnormal growth of blood vessels, and VMs, arising from developmental abnormalities in blood vessels, present multifaceted challenges in clinical practice. The review navigates through the clinical manifestations and classifications of these vascular anomalies, emphasizing the importance of accurate diagnosis based on clinical evaluation, imaging techniques, and histopathological assessment. Variations in presentation, ranging from asymptomatic lesions to severe complications impacting vital organs, underscore the necessity for comprehensive understanding and tailored management strategies. Moreover, this review examines current therapeutic modalities encompassing medical, interventional, and surgical interventions. It synthesizes the evolving landscape of treatment options and highlighting the benefits, limitations, and potential adverse effects associated with each approach. In addition, the review underscores the significance of a multidisciplinary approach, integrating expertise from dermatology, radiology, and surgery, to optimize patient care and outcomes. The challenges posed by these vascular anomalies necessitate ongoing research endeavors aimed at refining diagnostic criteria and advancing therapeutic innovations. This review amalgamates existing knowledge and providing clinicians and researchers with a comprehensive understanding of hemangiomas and VMs, thereby fostering continued exploration and innovation in this complex field.

Recent advancements in endovascular techniques have transformed the management of vascular malformations, shifting away from traditional surgical resections to less invasive methods like embolization and sclerotherapy. Vascular malformations are congenital anomalies resulting from embryonic angiogenesis failures, often misdiagnosed but manageable through a multidisciplinary approach. These malformations range from high-flow arteriovenous connections to low-flow venous, lymphatic, or mixed lesions, each requiring specific diagnostic and treatment strategies. Specific syndromes like Klippel–Trenaunay and Parkes–Weber require tailored approaches due to their unique presentations. Diagnosis relies on a combination of physical examination and advanced imaging techniques, including ultrasound and MRI. Treatment is focused on symptomatic relief and improving the patient's quality of life. Interventional treatment is indicated when conservative and/or medical management is insufficient. Surgical interventions remain relevant for select cases, often in a multidisciplinary context. Newer therapies, such as sirolimus, are emerging for complex, treatment-resistant cases. [ABSTRACT FROM AUTHOR]

Vascular malformations (VMs) are a heterogeneous group of arterial, venous, capillary, and/or lymphatic networks that typically are present at birth and grow with the patient. Signs and symptoms associated with VM range from absent to severe, with a broad spectrum of pain, cosmetic disfigurement, and local tissue destruction. Treatment options for these malformations extend from observation to surgical reconstruction. Each treatment modality has a role in the management of vascular anomalies, but also has specific challenges. Observation is not always sufficient, medical therapies may only be available for a subset of patients and are ultimately not curative, and surgical excision may itself be disfiguring or incomplete/not definitive. Sclerotherapy and/or embolotherapy have become a cornerstone of treatment for many types of VMs. These techniques are applicable to a wide range of VMs, are less invasive, have a shorter recovery period, and are repeatable. Although some VMs may not be amenable to percutaneous or endovascular treatment given their location, and multiple sessions may be required for select large and complex VMs, these minimally invasive treatments are often first line and may be definitive in treating VMs. Various agents may be used in sclerotherapy and embolotherapy, each with their own risks and benefits. Although there is a paucity of Level 1 evidence supporting the superiority of one agent over another, longstanding case series and expert experience exist, informing our knowledge of the safety and efficacy of sclerotherapy and embolotherapy. A brief overview of the most used sclerotherapy and embolotherapy agents and their uses is provided. [ABSTRACT FROM AUTHOR]

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder of the blood vessels that leads to the formation of telangiectasias and arteriovenous malformations (AVMs). HHT affects ∼1/5,000 people, but this varies significantly by geography and ancestry. The Curaçao criteria for HHT consist of four diagnostic criteria: spontaneous epistaxis, first-degree relative with HHT, AVMs in characteristic location (liver, lung, brain), and telangiectasias. Sequelae and major symptomology include recurrent epistaxis, dyspnea, heart failure, and stroke from paradoxical emboli among others. HHT patients are best cared for by a multidisciplinary team, ideally all with HHT-specific experience, but in this review, we will discuss the major aspects of the disease including etiology, diagnosis, and treatment recommendations. [ABSTRACT FROM AUTHOR]

A 59-year-old woman presented to our clinic with a 3.5× 3-cm protruding mass on her forehead. A skull X-ray revealed a radiolucent osteolytic lesion on the left side of the frontal bone. Additionally, computed tomography showed a 3.1× 1.7× 3.6-cm mass exhibiting a “sunburst” pattern situated between the outer and inner tables of the skull, just superior and lateral to the left frontal sinus. This pattern suggested the presence of an intraosseous vascular malformation (IVM). The lesion was approached via a bicoronal incision. En-bloc resection was performed, removing the mass along with approximately 0.5 cm of the surrounding normal bone without injury to the exposed frontal sinus mucosa. The exposed mucosa was reinforced with a galeal flap, and cranioplasty with bone cement was performed to repair the resulting bony defect. Pathological examination confirmed a diagnosis of intraosseous cavernous-type malformation with mixed cavernous and capillary histological features. We report this case of IVM and review the existing literature, highlighting the satisfactory functional and aesthetic outcomes after surgery. [ABSTRACT FROM AUTHOR]

Objective: This retrospective study aimed to perform a clinicopathological analysis of oral lymphangioma cases diagnosed at a reference service in oral pathology. Materials and Methods: A total of 40 cases with reviewed and confirmed histopathological diagnoses for oral lymphangioma were included in the study. Results: It was found that Caucasian women represented most of the sample, with the tongue and lower lip being the most affected sites. The most frequent clinical presentation of the lesions was as an asymptomatic reddish nodule. As for morphological characteristics, there was a slight predominance of simple lymphangioma (55%). Surgical removal was the therapeutic approach adopted in most cases. Conclusions: Despite OL being rare, it is essential that dentists and other professionals recognize variations in the clinical presentation and histopathological aspects of these lesions, differentiating them from other vascular lesions, and implementing correct treatment in each case. [ABSTRACT FROM AUTHOR]

Extra-axial cavernous hemangiomas (ECHs) are complex vascular lesions mainly found in the spine and cavernous sinus. Their removal poses significant risk due to their vascularity and diffuse nature, and their genetic underpinnings remain incompletely understood. Our approach involved genetic analyses on 31 tissue samples of ECHs employing whole-exome sequencing and targeted deep sequencing. We explored downstream signaling pathways, gene expression changes, and resultant phenotypic shifts induced by these mutations, both in vitro and in vivo. In our cohort, 77.4% of samples had somatic missense variants in GNA14 , GNAQ , or GJA4. Transcriptomic analysis highlighted significant pathway upregulation, with the GNAQ c.626A>G (p.Gln209Arg) mutation elevating PI3K-AKT-mTOR and angiogenesis-related pathways, while GNA14 c.614A>T (p.Gln205Leu) mutation led to MAPK and angiogenesis-related pathway upregulation. Using a mouse xenograft model, we observed enlarged vessels from these mutations. Additionally, we initiated rapamycin treatment in a 14-year-old individual harboring the GNAQ c.626A>G (p.Gln209Arg) variant, resulting in gradual regression of cutaneous cavernous hemangiomas and improved motor strength, with minimal side effects. Understanding these mutations and their pathways provides a foundation for developing therapies for ECHs resistant to current therapies. Indeed, the administration of rapamycin in an individual within this study highlights the promise of targeted treatments in treating these complex lesions. [Display omitted] Extra-axial cavernous hemangiomas (ECHs) are complex vascular lesions mainly found in the spine and cavernous sinus, and their genetic underpinnings remain incompletely understood. Here, we report somatic mutations of GNA14 , GNAQ , and GJA4 in ECH lesions. Furthermore, we present the utilization of rapamycin in treating an individual with GNAQ mutations. [ABSTRACT FROM AUTHOR]

Vascular malformations represent a heterogeneous spectrum of lesions that often present a diagnostic and therapeutic challenge, thus requiring a high index of clinical suspicion to reach a definitive diagnosis. Cloves syndrome is a rare overgrowth disorder of genetic etiology associated with a somatic activating mutation in PIK3CA, which is part of the PI3KAkt-mTOR intracellular signaling pathway. Clinically, it is characterized by congenital lipomatous overgrowth of any part of the body (mainly the thorax), accompanied by vascular and lymphatic malformations, epidermal nevi and structural abnormalities of the skeletal system such as scoliosis and alterations in the spine. The current therapeutic cornerstone for this syndrome is therapy with rapamycin, an mTOR pathway inhibitor. On the other hand, Klippel-Trenaunay syndrome is a complex vascular condition associated with overgrowth due to somatic mutations in the PIK3CA gene, along with chromosomal translocations and alterations in the VG5Q vascular gene. It is clinically characterized by a classic triad consisting of hemihypertrophy of the soft tissues and bones of an extremity, cutaneous hemangiomas, and varicose veins in anatomically abnormal positions. The main distinguishing characteristics of this syndrome are the presence of slow-type vascular anomalies without significant arteriovenous fistulas compared to Cloves syndrome. In both cases, the presence of overlapping clinical characteristics related to overgrowth syndromes with alterations in the PIK3CA gene highlights the challenge of an accurate diagnosis. [ABSTRACT FROM AUTHOR]

Background: Vascular malformations (VaMs) are caused by errors in vascular morphogenesis. Diagnosis and treatment can be complex. Few specialized centers care for these patients, and limited literature exists regarding their characteristics and clinical course. The vascular anomalies clinic (VAC) at the Instituto Nacional de Pediatría (National Institute for Pediatrics) is a multidisciplinary team and has been a reference center for patients with VaMs since 2012. We sought to describe the characteristics of patients cared for at the VAC, types of VaMs, treatments used, and clinical course. Methods: This was a descriptive, observational, retrospective, and cross-sectional study conducted from 2012 to 2022. Results: We included 435 patients with VaMs; the median age of presentation was 1 month. The most frequent signs and symptoms were increased volume (97.2%), superficial color change (65.5%), and pain (43.3%). The most common VaMs were lymphatic (36.7%) and venolymphatic (18.3%). Sclerotherapy was the most frequent treatment (73.4%), followed by medical treatment with sirolimus (18.5%); response to both was excellent/good in > 85% of cases. Conclusion: In this retrospective study of children with VaMs, we found that low-flow malformations were the most common, and sclerotherapy and sirolimus were the most frequently used treatments. The therapeutic response was excellent/good in most cases. [ABSTRACT FROM AUTHOR]

Objective: Gamma Knife radiosurgery (GKRS) is an effective and noninvasive treatment for high-risk arteriovenous malformations (AVMs). Since differences in GKRS outcomes by nidus type are unknown, this study evaluated GKRS feasibility and safety in patients with brain AVMs. Methods: This single-center retrospective study included patients with AVM who underwent GKRS between 2008 and 2021. Patients were divided into compact- and diffuse-type groups according to nidus characteristics. We excluded patients who performed GKRS and did not follow-up evaluation with magnetic resonance imaging or digital subtraction angiography within 36 months from the study. We used univariate and multivariate analyses to characterize associations of nidus type with obliteration rate and GKRS-related complications. Results: We enrolled 154 patients (mean age, 32.14±17.17 years; mean post-GKRS follow-up, 52.10±33.67 months) of whom 131 (85.1%) had compact- and 23 (14.9%) diffuse-type nidus AVMs. Of all AVMs, 89 (57.8%) were unruptured, and 65 (42.2%) had ruptured. The mean Spetzler-Martin AVM grades were 2.03±0.95 and 3.39±1.23 for the compact- and diffuse-type groups, respectively (p<0.001). During the follow-up period, AVM-related hemorrhages occurred in four individuals (2.6%), three of whom had compact nidi. Substantial radiation-induced changes and cyst formation were observed in 21 (13.6%) and one patient (0.6%), respectively. The AVM complete obliteration rate was 46.1% across both groups. Post-GKRS complication and complete obliteration rates were not significantly different between nidus types. For diffuse-type nidus AVMs, larger AVM size and volume (p<0.001), lower radiation dose (p<0.001), eloquent area location (p=0.015), and higher Spetzler-Martin grade (p<0.001) were observed. Conclusion: GKRS is a safe and feasible treatment for brain AVMs characterized by both diffuse- and compact-type nidi. [ABSTRACT FROM AUTHOR]

PIK3CA‐related overgrowth spectrum (PROS) encompasses different clinical entities caused by somatic activating mutations in PIK3CA. Among PROS, CLOVES syndrome represents a severe phenotype with poor survival rate. We present the case of a 4‐month‐old girl with CLOVES syndrome successfully treated with alpelisib, a PIKC3A inhibitor. [ABSTRACT FROM AUTHOR]

Object: The aim of the study was to investigate the safety, effectiveness, and peripheral nerve protection in ultrasound-guided microwave ablation (US-guided-MWA) for vascular malformations (VMs) closely related to peripheral nerve. Materials and Methods: From August 2019 to February 2022, 31 patients with 39 VMs received US-guided-MWA. All lesions were confirmed to be closely related to the peripheral nerve by imaging evaluation. Hydrodissection was applied to protect surrounding normal tissue, including peripheral nerves. The patients were followed up at 1day, 2 days, 3 days, 1 week, 1 month, 3 months after operation. Measurements of lesion volume, volume reduction ratio (VRR), sensory and functional abnormalities of adjacent nerves, number of treatments, complication details, personal satisfaction, recurrence, and symptom improvement were recorded. Results: Among the 39 VMs, the maximum volume is 128.58ml, while the minimum volume is 0.99ml. After a mean follow-up of 13.06 ± 4.83 months, the mean numerical rating scale (NRS) score decreased from 5.13 ± 1.65 to 0.53 ± 0.83 (P<0.0001). The mean mass volume was reduced from 18.34 ± 24.68 ml to 1.35 ± 2.09 ml (P=0.0001). The VRR of all lesions was 92.06%. However, the mean number of treatments was only 1.64 ± 0.87. All patients were satisfied with the technique, with a mean satisfaction score (SC) of 9.23 ± 1.13. There were no motor function abnormalities of the related nerves. 10 patients felt numbness in the ablation area after ablation, and gradually recovered after 1 month. Conclusion: US-guided-MWA serves as a novel alternative approach for patients with VMs. Preoperative evaluation of the relationship between VMs and peripheral nerves combined with intraoperative hydrodissection is an effective and safe method to prevent nerve injury. [ABSTRACT FROM AUTHOR]

Phleboliths are reported as calcifications that occur in vascular malformations, associated with changes in blood flow dynamics, thrombus formation and subsequent calcifications. Radiological examination, such as cone beam computed tomography (CBCT) could help in demonstrating the presence of a calcifiied mass. A 45-year-old male was referred to our service with an asymptomatic nodular purplish lesion located on the ventrolateral tongue. Within the lesion, a stony mass was also evident on palpation. A digital dental radiograph demonstrated two circumscribed radiopaque structures. Phleboliths associated with vascular malformation was the main diagnostic hypothesis. The patient underwent a sclerotherapy protocol allowing surgical accessibility to the area. Phlebolyts were surgically removed using electrocoagulation. Histopathological examination revealed phleboliths in the context of a vascular malformation with intense fibrosis. [ABSTRACT FROM AUTHOR]

This narrative review aims to summarise the classification of vascular anomalies, their clinical presentation, and their radiological features to propose a diagnostic algorithm to approach patients with suspected soft tissue vascular anomalies of the extremities. The management of vascular anomalies necessitates a multidisciplinary approach. Clinical presentation and physical examination are sufficient in most cases to achieve a correct diagnosis. This is especially true for small congenital lesions of the skin and subcutaneous tissue. Imaging is used for accurate characterization of these lesions, especially in cases of atypical or vague clinical presentation, and to assess extension in cases of lesions that are larger and localized in deeper tissues. [ABSTRACT FROM AUTHOR]

Bronchial Dieulafoy's disease (BDD), remains poorly understood, with only 88 cases reported globally. Herein, we present the largest case series (n = 7) from a single centre, between 2017 and 2023, retrospectively reviewed, detailing clinical presentations, diagnoses, management and up to 4‐year follow‐up outcomes. Diagnosis relied on characteristic lesions detected through white light bronchoscopy with or without endobronchial ultrasound (EBUS) or narrow band imaging (NBI), along with computed tomography (CT) scans or bronchial angiography. Identification of aberrant vessels beneath lesions and bronchoscopy details were documented. Treatment modalities and follow‐up outcomes until December 2023 were noted. All patients were non‐smokers. Review of imaging findings by an experienced radiologist was crucial in suspected cases due to risk of bleeding and often unconclusive results from biopsy. Management of BDD varied, with six patients undergoing bronchial artery embolization (BAE) and one requiring lobectomy; four patients received additional endobronchial therapy, one died due to malignancy, none experienced recurrence of haemoptysis. Identifying patients with large volume haemoptysis disproportionate to parenchymal disease in CT scans is important. A bronchoscopic surveillance is crucial to avoid biopsy; it can be confirmed using EBUS of NBI. While no established guidelines exist, BAE and endobronchial therapy emerge as valuable interventions, with surgical resection reserved for recurrent cases. [ABSTRACT FROM AUTHOR]

ObjectiveThis review aims to summarize the salvage experience of cardiopulmonary collapse occurring as a result of absolute ethanol sclerotherapy for vascular malformations.MethodsIn total, we reviewed three cases of cardiopulmonary collapse induced by ethanol sclerotherapy for vascular malformations and described the details of the salvage procedure. Saturation of pulse oxygen (SpO2), end-tidal CO2, and invasive arterial pressure were the routine monitors for ethanol injection patients. Cardiopulmonary resuscitation, epinephrine, norepinephrine, and deoxyepinephrine were mainly used to correct circulation parameters. Manually ventilated via endotracheal intubation with 100% O2, increased respiratory rate were mainly used to correct Respiratory parameters.ResultsAll three cases were successfully salvaged without major complications. When cardiopulmonary collapse occurred, manual ventilation via endotracheal intubation with 100% O2, increased ventilation frequency and external cardiac compression were the emergency treatments. Epinephrine, norepinephrine, deoxyepinephrine infusion solely or combined were crucial to maintaining the basic vital signs.ConclusionDespite the severity of cardiopulmonary collapse caused by ethanol sclerotherapy, it can be detected by close observation and reversed with timely treatment.

A basic understanding of vascular anomalies will aid physicians-in-training as they seek to properly diagnose and determine interventions for these patient presentations. The aim of this review is to create a resource for physicians in training that encompasses the most important clinical aspects of vascular anomalies. Vascular anomalies of the head and neck are divided into two categories: vascular tumors and vascular malformations. This review will first describe vascular tumors followed by vascular malformations. This review discusses major pathology found in both categories of vascular anomaly. Vascular anomalies are frequently found in pediatric populations and can persist into adulthood, making it important for trainees to identify them on physical exam. This developing field seeks to improve form, function, and quality of life for patients with vascular anomalies and often requires a multidisciplinary approach (i.e., otolaryngology, dermatology, genetics, plastic surgery, interventional radiology). Various medical and surgical treatment options are available. A basic knowledge of these anomalies will allow for accurate, early diagnosis and appropriate intervention which can ultimately improve patient outcomes. Search Strategy and Selection Criteria: The MEDLINE/PubMed database was searched for primary research and reviews discussing various vascular anomalies which include infantile hemangioma, congenital hemangioma, pyogenic granuloma, tufted angioma, kaposiform hemangioendothelioma, capillary malformations, lymphatic malformations, venous malformations, and arteriovenous malformations. This search was conducted from 7/5/2023 to 3/21/2024.

Background: AV malformations are aberrations in the development of vessels with varied presentations that may lead to aesthetic, limb and life-threatening complications. Identification and treatment of the vascular malformations is a challenging task for surgeons. Aims & Objectives: To study clinical presentation/ diagnostic modalities/ treatment strategies, complications and recurrence rates of surgical and other interventional strategies. Material and Methods: A retrospective study of 150 patients who were treated over a period of 3 years from a tertiary centre with regular follow-ups was done to study the best diagnostic and treatment plans for initial and recurrent lesions. Results: The study showed an age group of

ABSTRACT We report five cases of spider angiomas in children treated topically with timolol 0.5% (ophthalmic solution or gel‐forming solution), for 6 months. Parents and patients were advised to apply one drop twice daily. Four of them showed either partial (2) or complete response (2) and only one patient had no clinical change. No adverse effects were reported. This pilot case series shows that topical timolol may prove useful as a noninvasive, available and well‐tolerated treatment option for spider angiomas in children who seek a treatment alternative to pulsed dye laser. [ABSTRACT FROM AUTHOR]

Klippel–Trenaunay Syndrome (KTS) is a rare congenital vascular disorder characterized by extensive capillary and venous malformations that pose unique challenges during pregnancy. This case report discusses the successful management of a 34‐year‐old pregnant woman with KTS who had two caesarean sections, resulting in the birth of two healthy babies. Despite the lack of evidence‐based guidelines for obstetrical management in KTS, a multidisciplinary team collaborated to devise a high‐risk thrombosis management plan, involving the use of compression stocking and low molecular weight heparin prophylaxis. The patient's elevated risk of thrombosis, exacerbated during pregnancy, informed the decision of caesarean sections, aligning with finding that in most KTS pregnancies, this method of delivery based on obstetric indications and arteriovenous malformations is chosen. This case highlights the importance of systematic and patient‐centered care, advocating for comprehensive obstetric management guidelines to address the unique challenges posed by KTS during pregnancy. Further research is warranted to enhance our understanding and refine guidelines for individuals with vascular abnormalities linked to KTS. [ABSTRACT FROM AUTHOR]

Vascular malformations are intricate anomalies of the circulatory system, presenting a diverse array of clinical manifestations, and posing significant challenges in diagnosis and treatment. The pathogenesis of vascular malformations is explored through the lens of genetic and molecular mechanisms, shedding light on the pivotal role of somatic mutations and dysregulated signaling pathways. Clinical presentations of vascular malformations are widely variable, ranging from cosmetic concerns to life-threatening complications. The utility of imaging techniques, such as magnetic resonance imaging (MRI), computed tomography (CT), and angiography, are discussed in detail, emphasizing their role in precise delineation and characterization. Therapeutic strategies for vascular malformations are multifaceted, considering factors such as lesion size, location, potential complications, and patient-specific factors. Traditional interventions, including surgical excision and embolization, are appraised alongside emerging approaches like targeted molecular therapies and minimally invasive procedures. The manuscript underscores the need for an individualized treatment approach, optimizing outcomes while minimizing risks and complications. In summation, this manuscript offers a comprehensive analysis of vascular malformations, encompassing their underlying pathogenesis, clinical nuances, diagnostic methods, and therapeutic considerations. By synthesizing current knowledge and highlighting gaps in understanding, this review serves as a valuable resource for clinicians, researchers, and medical practitioners, fostering an enhanced comprehension of vascular malformations and paving the way for improved patient care and innovative research endeavors.