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Abstract
Vascular malformations may typically present with palpable mass that can be either asymptomatic or can present with symptoms including swelling and pain. On rare occasions, vascular malformation of muscle may produce joint deformities caused by contracture of the involved muscle. When vascular malformation involves the flexor muscle of the leg, ankle equinus deformity may occur. However, there are no reports of toe deformities secondary to intermuscular or intramuscular vascular malformations of flexor muscles of toe. Thus, we report a case of vascular malformation of flexor hallucis longus muscle with flexion contracture of toes in a 40-years-old woman who was treated with surgical excision.
References
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Figure 1.
Photographs showing (A-C) flexion contracture deformities of toes and (D, E) flexion contracture deformity was increased when ankle dorsiflexion and note that affected ankle had limitation of dorsiflexion.
Figure 2.
Tibia AP (A) and lateral (B) X-ray: irregular margin and irregular bony spur lesion on distal fibular and tibia was seen.
Figure 3.
MRI sagital plane (A) T1-weighted image showed heterogenous mass lesion in flexor hallucis longus muslce (FHL), (B) T2-weighted image showed high signal intensity in mass and axial plane (C) T1-weighted image showed heterogenous mass lesion in FHL and neurovasulcar bundle, (D) T2-weighted image showed focal high signal intensity in mass of FHL and neurovasuclar bundle, (E) T1-enhanced image showed enhanced mass in FHL.
Figure 4.
(A) 5.5×2.3 cm sized vascular malformation was excised. (B) The lumen (0.2 cm) was identified in the center of mass transsection.
Figure 5.
Photographs showing that flexion contracture deformity of toe was not found despite dorsiflexion of ankle.
Figure 6.
Histology (A, B) showed proliferation of variable dilated, angulated, thick-walled vascular channels (H&E, A: ×100, B: ×400).
Figure 7.
MRI sagital plane (A) T1-weighted image, (B) T2-weighted image showed that flexor digitorum longus (arrow) did not adhere to tibial bone and around soft tissue.
Table 1.
Classification of Vascular Anomalies
| Tumors of childhood | Malformation |
|---|---|
| 1) Hemangioma | 1) Capillary malformation |
| 2) Kaposiform hemangioendothelioma* | 2) Venous malformation |
| 3) Arteriovenous malformation | |
| 4) Mixed malformation |
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