Presentation
Patient presented with painless left foot swelling since early childhood.
Patient Data
An infiltrative lobulated outline lesion seen localized mainly to the medial aspect planter surface of the left mid foot region. The lesion seen insinuating and encasing regional intrinsic muscles, neurovascular bundles, tendons and soft tissues, but no significant signal changes seen within adjacent metatarsal bones cortex or marrow. It shows a trans spacial spread across different tissue compartments, passing in the inter meta tarsal spaces to reach the dorsum of foot.
The signal character of the lesion is slightly hyperintense to muscles on T1, hyperintense on T2, highlighted bright of fat saturation sequences, heterogeneously enhancing following IV-GADO contrast interrogation.
Multiple scattered tiny hyperdense calcific foci noted within the infiltrative soft tissue lesion in the left mid foot region consistent with phelibolie.
Confirmation of the intact boney structures of left foot that are in close contact to the described extraosseous lesion with no significant abnormality in the whole visible bones of the scan.
Case Discussion
The diagnosis is benign soft tissue venous vascular malformation that belongs to slow flow vascular malformation category according to ISSVA classification of vascular anomalies. This case represents an aggressive behavior of a benign lesion. The descriptive buzzword for this kind of lesion is trans spacial spread as it insinuate and incorporate into potential spaces between local anatomical structures making the lesion non excisable.
The key diagnostic feature in such condition is the presence of phelibolith / pheliboli which are elegantly demonstrated on CT scan much better than plan radiograph.
Unable to process the form. Check for errors and try again.