An Adolescent Girl with an Abdominal Mass
A
14-year-old girl presented with a 6-month history of swelling in the left lower quadrant of her abdomen. The patient was asymptomatic and her only complaint was “cosmetic distresses” due to the mass. Her medical history was unremarkable. Physical examination was normal except for the pulsatile soft mass with an approximately 6-cm diameter in the left lower region of her abdomen; this was located under the skin, and a palpable thrill was present. Laboratory tests were normal (acute phase reactants, blood count, kidney and liver tests, and urine analysis). Contrast-enhanced abdominal computed tomography revealed an arteriovenous vascular malformation (AVM) in tortuous form (Figures 1 and 2). Transcatheter embolization was performed due to the cosmetic complaints and the location of the mass in a superficial area. Six feeder arteries of the lesion were monitored via angiography, and embolization was applied to ninth, tenth, and eleventh intercostal arteries from the thoracic aorta and to 3 inferior epigastric arteries separated from the left iliac artery. The mass was reduced and the lesion completely regressed. AVMs are generally sporadic and latent during infancy and childhood but expand with an underlying thrill or bruit noted during adolescence. The hormonal changes of puberty or local trauma may trigger expansion.1 In the treatment of an AVM, the main goal is to obtain complete eradication
Figure 2. Three-dimensional computed tomography image of AVM.
of the nidus. Transcatheter and percutaneous nidal embolization is often the first therapeutic option.2 n Demet Alaygut, MD Department of Pediatric Nephrology
Ferhat Sezer, MD Department of Radiology
Cengiz G€ uney, MD Department of Pediatric Surgery
Suar Caki Kilic, MD Department of Pediatrics
Orhan Solak, MD Department of Radiology Faculty of Medicine Cumhuriyet University Sivas, Turkey
References Figure 1. Arteriovenous malformation and its drainage vein. J Pediatr 2014;164:940. 0022-3476/$ - see front matter. Copyright ª 2014 Mosby Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2013.11.023
940
1. Cahill AM, Nijs LF. Pediatric vascular malformations: pathophysiology, diagnosis, and the role of interventional radiology. Cardiovasc Intervent Radiol 2011;34:691-704. 2. Lee BB, Do YS, Yakes W, Kim DI, Mattassi R, Hyon WS. Management of arteriovenous malformations: a multidisciplinary approach. J Vasc Surg 2004;39:590-600.
A
14-year-old girl presented with a 6-month history of swelling in the left lower quadrant of her abdomen. The patient was asymptomatic and her only complaint was “cosmetic distresses” due to the mass. Her medical history was unremarkable. Physical examination was normal except for the pulsatile soft mass with an approximately 6-cm diameter in the left lower region of her abdomen; this was located under the skin, and a palpable thrill was present. Laboratory tests were normal (acute phase reactants, blood count, kidney and liver tests, and urine analysis). Contrast-enhanced abdominal computed tomography revealed an arteriovenous vascular malformation (AVM) in tortuous form (Figures 1 and 2). Transcatheter embolization was performed due to the cosmetic complaints and the location of the mass in a superficial area. Six feeder arteries of the lesion were monitored via angiography, and embolization was applied to ninth, tenth, and eleventh intercostal arteries from the thoracic aorta and to 3 inferior epigastric arteries separated from the left iliac artery. The mass was reduced and the lesion completely regressed. AVMs are generally sporadic and latent during infancy and childhood but expand with an underlying thrill or bruit noted during adolescence. The hormonal changes of puberty or local trauma may trigger expansion.1 In the treatment of an AVM, the main goal is to obtain complete eradication
Figure 2. Three-dimensional computed tomography image of AVM.
of the nidus. Transcatheter and percutaneous nidal embolization is often the first therapeutic option.2 n Demet Alaygut, MD Department of Pediatric Nephrology
Ferhat Sezer, MD Department of Radiology
Cengiz G€ uney, MD Department of Pediatric Surgery
Suar Caki Kilic, MD Department of Pediatrics
Orhan Solak, MD Department of Radiology Faculty of Medicine Cumhuriyet University Sivas, Turkey
References Figure 1. Arteriovenous malformation and its drainage vein. J Pediatr 2014;164:940. 0022-3476/$ - see front matter. Copyright ª 2014 Mosby Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2013.11.023
940
1. Cahill AM, Nijs LF. Pediatric vascular malformations: pathophysiology, diagnosis, and the role of interventional radiology. Cardiovasc Intervent Radiol 2011;34:691-704. 2. Lee BB, Do YS, Yakes W, Kim DI, Mattassi R, Hyon WS. Management of arteriovenous malformations: a multidisciplinary approach. J Vasc Surg 2004;39:590-600.
![[Abdominal mass in an adolescent].](/assets/img/hold.png)
