HAEMANGIOMA IN BASE OF THE TONGUE

22 yr old with H/o oral cavity bleeding

( spontaneous ) The bleeder was

ligated under GA . Lesion was found at base of the tongue. ( ? Haemangioma

Left side base of the tongue).

MERCURY IMAGING INSTITUTE SCO 172-173 SEC 9C CHANDIGARHMERCURY IMAGING CENTRE SCO 16-17 SEC 20D CHANDIGARH

Practical Ready Reference points

• VASCULAR MALFORMATIONS ARE EITHER

1. Arterial2. Venous3. Capillary4. Lymphatic

• Phleboliths are common in venous malformations.

• Size of the vascular malformations may change with trauma, infection , endocrine changes ( puberty,pregnancy).

• Involution / regression – common with capillary haemngioma’s

• MR angiogram demonstrates feeding arterial tree in High flow malformations ( poor demonstrations in low flow malformations).

• Signal voids are appreciated with serpentine pattern of vasculature in the basic MR sequences especially in case of Arterial malformations.

• Venous malformations are the common lesions in the oral cavity. May be associated with blue rubber bleb syndrome.

• Maffucci’s syndrome – Associated with multiple enchondroma’s

Brief about haemangioma’s............

• Vascular malformation of the tongue comprise significant proportion of angiodysplastic lesions of the head/ neck region ..... Haemangioma of the base of the tongue per se is rare lesion.

• Phleboliths are appreciated on conventional imaging / plain CT study.

• Lobulated lesion is appreciated with possible mass effect .

• Before intervention – Cross sectional imaging with CT/MR should be done .

Present case....................

• Lobulated mass with epicentre on the left side of the tongue in young adult male . H/o profuse bleeding – Bleeder ligated under GA.

• MR study – Signal voids appreciated in the core of the lesion with Dilated prominent lingual artery with ramifications extending into the core of the lesion. No frank dilated draining veins appreciated .

• Findings are corroborative with High flow vascular malformations .

SIGNAL VOIDS IN THE SUBSTANCE OF

THE LESION

Dilated prominent lingual branch of the left ECA with

further arterial Ramifications supplying the

lesion

LEFT SIDE LINGUAL BRANCH OF ECA

RT SIDE LINGUAL BRANCH OF ECA

The lingual artery is one of the branches of the external carotid artery and supplies the oral floor and tongue.Summary•origin: branch of the external carotid artery at the level of the C3•course: towards hyoid, then loops down towards the tongue•supply: oral floor and tongue•termination: tongue•key relationships: loop is crossed by the hypoglossal nerve

DISPROPORTINATLE LARGE LINGUAL BRANCH OF THE LEFT SIDE ECA.

RAMIFICATIONS AS DEMONSTARTED WITH REFORMATED IMAGES.

LINGUAL BRANCH OF LEFT SIDE ECA

REFORMATION

To conclude................................

• MR angiogram demonstrates Feeding arterial tree more so in High flow vascular malformations.

• Signal voids , Lobulated outline , serepentine pattern of core vessels , Feeding arteries , draining veins – Help in assessing / categorising the vascular malformation.

• Regression / involution/ augmentation of size has to be assesed ( temporal evolution).