Real-time Ultrasound-guided ethanol Sclerotherapy of a Symptomatic Venous Malformation: a case report

A 13-year-old girl had a venous malformation at her abdductor pollicis longus muscle of right forearm, with clinical presentation of local swelling, tenderness and inability to abduct her thumb. Under sonographic guidance, we treated this lesion with percutaneous intralesional ethanol injection. Her symptoms soon resolved after the treatment. In a follow-up period of 8 months, persistently decreased size of the lesion was observed without recurrence of symptom. We believe that US-guided ethanol injection is an easy, effective and safe therapy in relieving symptom associated with the venous malformation. Venous malformations are the most common vascular malformations [1]. The diagnosis of venous malformation could usually be done if there are typical clinical and imaging findings. These lesions are present at birth, tend to enlarge over time in proportion to the growth of the patient and do not spontaneously regress [2]. Most common symptoms include pain and swelling, which depend on their size and location. Under sonography, they usually appear as hypoechoic and heterogeneous masses with compressibility [3]. Sometimes, acoustic shadowing produced by phleboliths could be found. Current management of these symptomatic lesions includes medical treatment, sclerotherapy and surgical resection [4]. Herein, we report a case with symptomatic intramuscular venous malformation, which was successfully treated by intralesional ethanol injection under real-time US-guidance [5].