Definition — Vascular Malformation (Cheek Soft Tissue): A vascular malformation of the cheek soft tissue is a congenital structural anomaly of blood vessels, usually classified as low-flow (venous/capillary/lymphatic) or high-flow (arteriovenous) malformations. These lesions are present at birth, grow proportionately with the patient, and do not regress spontaneously. Venous malformations are the most common type in the cheek region.
Ultrasound Report — Line: A well-defined, compressible lesion is noted in the subcutaneous soft tissue of the left cheek, composed of multiple hypoechoic tubular channels. Color Doppler demonstrates slow venous flow without arterialization. No solid component or significant calcification identified. Surrounding fat planes are preserved, and there is no muscle or bone involvement.
Conclusion: Findings are consistent with a low-flow venous vascular malformation of the cheek soft tissue.
Recommendation: Recommend further evaluation with contrast-enhanced MRI for extent mapping and referral to a vascular anomalies team (Interventional Radiology / Maxillofacial or Plastic Surgery) for treatment planning (sclerotherapy ± surgical excision).
Sonographic Features — Vascular Malformation:
- Lesion: Well-defined, compressible soft tissue lesion.
- Channels: Multiple tubular hypoechoic vascular channels.
- Doppler: Low-velocity venous flow, no arterial waveform.
- Calcification: Phleboliths may be seen as echogenic foci with posterior shadowing.
- Surrounding tissues: Fat planes preserved, no muscle or bone invasion.
Causes / Etiology — Vascular Malformation:
- Congenital developmental anomaly of venous channels (most common).
- Failure of normal vascular remodeling during embryogenesis.
- Often sporadic; rarely associated with syndromes (e.g., Klippel-Trénaunay).
Symptoms / Clinical Features — Vascular Malformation:
- Soft, compressible swelling of the cheek.
- Bluish discoloration of overlying skin or mucosa.
- Swelling increases with Valsalva maneuver or dependent position.
- Occasional pain, thrombosis, or palpable phleboliths.
- Facial asymmetry or cosmetic deformity.
Diagnostic Strategy — Vascular Malformation:
- Ultrasound with Doppler: First-line modality to assess venous channels, compressibility, and slow flow.
- MRI with contrast: Best for mapping lesion extent, vascularity, and relation to adjacent structures.
- CT scan: Helpful if phleboliths or bony involvement suspected.
- Differentials: Venolymphatic malformation, hemangioma, dermoid cyst, soft tissue sarcoma (rare).
Declaration:
I, R. K. Mouj, hereby declare that the material presented in this document titled "Vascular Malformation (Cheek Soft Tissue): Definition, Sonographic Features, Case Studies, and Risk Assessment" has been prepared and compiled by me for educational purposes only. It is intended for learning, training, and academic reference. Sources and references have been acknowledged where appropriate.
Ethics / Patient Data Statement: Any patient images, case material, or ultrasound examples included here are for academic use only, anonymised, and used with ethical consideration.
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