Vascular lesions constitute one of the most important but difficult diagnostic and therapeutic enigmas in the head and neck region. They are divided into two major subtypes according to the ISSVA classification system as Vascular Neoplasms and Vascular Malformations. We present a rare case of massive slow flow vascular malformation involving the tongue and oropharynx which was managed successfully by Interventional Radiology procedure.
Case Report:
A 22 year male presented with painless gradually increasing swelling involving the right lateral aspect of the tongue ( Fig 1). According to the patient it was present since childhood but became symptomatic since last 1 year due to rapid increase in size causing difficulty in swallowing. It was
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Then the patient was subjected for Magnetic Resonance Imaging (MRI). On MRI scan, there was a large lesion composing vascular spaces which were seen extending into the floor of mouth and right parapharyngeal space. There was an exophytic component of the lesion causing partial obliteration of oral cavity. On Dynamic Contrast MRI there was gradual progressive contrast retention within the vascular spaces and no significant arterial feeders and early draining veins were noted (Fig 2 C-F). The imaging diagnosis of slow flow venous malformation was considered. Due to morbid nature of surgery, patient was referred to Intervention Radiology department for management by serial sessions of sclerotherapy. Patient was taken up for sclerotherapy after upfront tracheostomy and Ryle’s tube insertion done as a precautionary measure to overcome anticipated post procedure airway and pharyngeal compromise. Under Ultrasound guidance using 22G scalp vein needle set, direct puncture of vascular spaces was done. After confirmation of free back flow of blood, Sodium tetradecyl sulphate mixed with low osmolar non ionic iodinated contrast