Section Editor: Sandy Cheng-Yu Chen, M.D.
Taipei Medical University Hospital, Taipei, Taiwan
Venous malformations (VMs) are congenital and one of the most common vascular malformations in the head and neck. The low-flow characteristics of VM promote stasis and eventually dystrophic calcification leading to phleboliths that can be found in VM of nearly all adult patients. These calcifications are considered the key imaging finding of VM on CT (A, yellow arrow). The extent of the VM is usually well shown on CT (A, white arrow). They are typically lobulated, giving the characteristic “bunch of grapes” configuration. On MRI, the VM typically appears as isointense or hypointense lesions on T1 (B, arrow) and markedly hyperintense on T2 (C, yellow arrow) with variable but generally moderate enhancement (D, arrow). Septations and rounded signal voids (C, white arrow) corresponding to phleboliths are additional distinguishing features. The treatment method may be invasive or noninvasive depending on the risk of severe hemorrhage, location, accessibility, depth of invasion, age, and cosmetic issues.