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Early Versus Later Presentations of Venous Malformations: Where and Why?

Authors

  • Sinae A. Vogel M.D.,

    1. School of Medicine, University of California, San Francisco, San Francisco, California
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  • Christopher P. Hess M.D., Ph.D.,

    1. Department of Radiology, University of California, San Francisco, San Francisco, California
    2. Department of Biomedical Imaging, University of California, San Francisco, San Francisco, California
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  • Christopher F. Dowd M.D.,

    1. Department of Radiology, University of California, San Francisco, San Francisco, California
    2. Division of Interventional Neuroradiology, University of California, San Francisco, San Francisco, California
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  • William Y. Hoffman M.D.,

    1. Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California
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  • Ari J. Kane M.D.,

    1. School of Medicine, University of California, San Francisco, San Francisco, California
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  • Roxanne Rajaii M.A.,

    1. School of Medicine, University of California, San Francisco, San Francisco, California
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  • Ilona J. Frieden M.D.

    Corresponding author
    1. Department of Dermatology, University of California, San Francisco, San Francisco, California
    2. Department of Pediatrics, University of California, San Francisco, San Francisco, California
    • School of Medicine, University of California, San Francisco, San Francisco, California
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Address correspondence to Ilona J. Frieden, M.D., Department of Dermatology, University of California at San Francisco, 1701 Divisadero Street, Box 0316, San Francisco, CA 94115, or e-mail: friedeni@derm.ucsf.edu.

Abstract

Venous malformations (VMs) are congenital anomalies of the venous vasculature, but not all are evident at birth. The factors that lead to presentation later in life are not well understood. The objective of this retrospective cohort study of patients with VMs evaluated at the University of California at San Francisco Birthmarks and Vascular Anomalies Center from 2005 to 2009 was to investigate the clinical presentation of VMs and correlate these features with different types of tissues (e.g., skin, subcutis, intramuscular). Main outcomes included the age at which lesions were first noticed, tissue type involved, presenting signs and symptoms, aggravating factors, and morbidities. A total of 115 subjects was included. The mean age when VM was first noted was 6.7 ± 0.9 years. Tissue types involved included skin/subcutaneous (46%); intramuscular (40%); and bone, tendon, or joint (14%). Presenting signs/symptoms included soft tissue swelling (44%), discrete mass (34%), pain (33%), and skin discoloration (26%). When compared with VMs limited to the skin or subcutis, those restricted to the intramuscular compartment were less likely to present at birth (27% vs 53%, p < 0.05) but were more frequently painful (79% vs 60%, p < 0.05) and contained more phleboliths (28% vs 11%, p < 0.05), and were associated with more exercise limitation (35% vs 16%, p < 0.05). VMs differ in age of onset, clinical features, and complications based on differing tissues and sites of involvement, with isolated intramuscular involvement associated with later presentation and greater morbidity.

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