Name : Maryam
Resident : ----------------
Gender : Female
Age : 20
A 20-year-old female with an ulcer at plantar aspect of right foot.
Imaging Procedures and Findings
The 20-year-old woman further evaluated about an ulcer at plantar aspect of her foot using DSA. Previous color Doppler study depicted monophasic continuous waveform associated with raised both PSV & EDV in arteries of the leg. Performed DSA revealed, rapid arterial flow (anterior & posterior tibialis arteries), rapid venous contamination & early venous drainage indicative for high flow AVM.
The best diagnostic clue is diffuse mass of dilated tortuous serpiginous vessels involving both arteries and veins. Upon the degree of arterial-venous shunting it could be from "low flow" venous to "high flow'' arterial shunting. High flow AVMs seen during arterial phase, but low flow AVMs seen on delayed venous phase. Arteriovenous Fistula is in differential diagnosis but it is usually an acquired abnormality (trauma, iatrogenic) & relates to direct connection between adjacent artery and vein. It lacks multiple feeders and is high flow communication. A vascular neoplasm such as hemangioma presents in infancy then proliferates and usually involutes during adulthood. It is low flow malformation, with normal-caliber feeding vessels, early nodular filling of vascular spaces that persists through venous phase (contrast pooling). Soft tissue sarcoma is an enhancing mass with no feeding or draining vessels.
High flow AVM of foot.
Diagnostic Imaging Cardiovascular, Abbara, Walker et al. Fundamental of diagnostic radiology, William E. Brant, Clyde A. Helms.