Question of the day: Which of the following statements about vascular anomalies is true?

Question:

Which of the following statements about vascular anomalies is true?

	1. Vascular malformations are true neoplasms.
	2. Infantile hemangiomas do not usually regress.
	3. Hepatic arteriovenous malformations (AVMs) are congenital lesions.
	4. Vascular neoplasms are subdivided into slow-flow and high-flow lesions.
	5. Arteriovenous malformations are rarely seen in hereditary hemorrhagic telangiectasia patients.

Answer:

The correct answer for the question "Which of the following statements about vascular anomalies is true?" is:

3. Hepatic arteriovenous malformations (AVMs) are congenital lesions.

Explanation
A. Vascular malformations are not true neoplasms. Rather, they are congenital lesions comprised of dysplastic blood vessels. [Vascular anomalies of a neoplastic origin exhibit increased cell proliferation constituting a soft tissue mass whereas vascular malformations do not. Rather, they solely consist of dysplastic blood vessels that grow in proportion with the child as they mature.]
B. Infantile hemangiomas usually regress as the child ages. [Infantile hepatic hemangiomas are small or occult at birth and tend to involute during childhood, whereas hepatic AVMs are present at birth and grow in proportion with the child.]
C. Hepatic arteriovenous malformations are indeed congenital lesions. [Arteriovenous malformations are present at birth and grow in proportion with the child. Although congenital, AVMs may initially be clinically silent and present later in life including adulthood.]
D. Vascular malformations not neoplasms are subdivided into slow-flow and high-flow lesions. [Furthermore, vascular malformations can be subdivided into slow-flow (e.g. venous malformation) and high-flow (e.g. arteriovenous malformation) lesions based upon the presence or absence of an arterial component.]
E. Arteriovenous malformations are commonly seen in hereditary hemorrhagic telangiectasia patients. [AVMs are commonly seen in hereditary hemorrhagic telangiectasia (HHT) patients, however, a neonatal presentation of an HHT-associated hepatic AVM is also limited to case reports.]

From the manuscript:
Transarterial Embolization of a Hepatic Arteriovenous Malformation in an Infant Using Onyx: A Case Report and Review of the Differential Diagnosis Imaging Findings
Radiology Case. 2014 Aug; 8(8):33-42

This article belongs to the Interventional section.

From the manuscript

Transarterial Embolization of a Hepatic Arteriovenous Malformation in an Infant Using Onyx: A Case Report and Review of the Differential Diagnosis Imaging Findings

Free full text article: Transarterial Embolization of a Hepatic Arteriovenous Malformation in an Infant Using Onyx: A Case Report and Review of the Differential Diagnosis Imaging Findings

Abstract
Hepatic arteriovenous malformations are rare congenital lesions associated with significant morbidity and mortality, most commonly from high output cardiac failure. Efficient diagnosis and treatment demands an interdisciplinary approach, and the interventional radiologist plays a pivotal role in both. Imaging is important for diagnostic accuracy and treatment planning, and transcatheter embolization has become an established primary therapy. We report the clinical and imaging findings of a rare hepatic arteriovenous malformation in an infant presenting with high-output cardiac failure and pulmonary artery hypertension that was successfully treated by transarterial embolization using Onyx.

References

1. Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg 1982; 69:412-422