Vascular malformation of the face detected on a bone scan

Overview

67-y-old lady was sent to our department for a bone scan due to a fall to the left knee because of a vertigo. She had a hypertension and a post-traumatic epileptic syndrome stabilized with an appropriate therapy. Total thyreoidectomy was performed years ago due to a papillary thyroid carcinoma, follow-up examinations were always negative. Also hysterectomy and cholecystectomy were done years ago as well as total knee prosthesis due to a serious arthrosis.

Bone scan was performed as a two-phase examination with an early imaging of a blood pool distribution after 15 minutes post injection of 940 MBq of ^99mTc-HDP (patient weight was 94 kg) with a dual-head SPECT gamma camera BrightView XCT. This scan revealed expected increased blood-pool in the region of the left knee after falling but moreover there was also increased radiopharmaceutical accumulation in the region of her right face. (Fig. 1) On the late scan performed after 3 hours post injection, physiological distribution of the bone metabolic turnover corresponding to her age was detected with increased one in the region of the left knee, the right face was without any pathology. (Fig. 2). Careful clinical examination proved a slight bluish shine of a vascular malformation at this location; it was confirmed by the patient after a targeted question. She was diagnosed with a venous or capillary-venous malformation localized in the right side of her face laterally to a mandible of the size of 9 x 4.5 cm with an intracranial propagation to the temporo-basal area using angiography and magnetic resonance imaging years ago.

Key Words:
vascular malformation, bone scan