Phleboliths in digital vascular malformations in a child.

An 8-year-old girl presented with swollen right third, fourth, and fifth fingers since birth, progressive enlargement, and occasional itching. She neither had other symptoms, including numbness or paresthesias, nor had a history of trauma or similar complaints within her family. On examination, swelling with visible dilated veins (Fig. 1A) was noted over her right third, fourth, and fifth fingers, while the rest of her examination was normal. X-ray imaging of the right hand revealed phleboliths on the right third finger (Fig. 1B). Doppler ultrasonography showed a vascular malformation (VM) with a mixed arterial and venous flow with echogenic foci suggestive of phleboliths. The management plan suggested was surgical intervention. Congenital VMs are inborn errors in angiogenesis and vasculogenesis during fetal development, and venous malformations are the most common type of VMs.1Mattassi R.E. Giuseppe P.D. Venous malformations of the hand: surgical treatment.Phlebolymphology. 2022; 29: 51-59Google Scholar Phlebolith, a type of vascular calcification, is encountered frequently in VMs, predominantly in venous malformations. Sluggish blood flow in the VMs leads to stagnation, thrombosis, and subsequent formation of phleboliths, which indicated calcified thrombi.2Bhat V. Bhat V. Shining Pearls sign: a new identity for venous malformations on computed tomographic imaging.Int J Angiol. 2016; 25: e21-e24Crossref PubMed Scopus (1) Google Scholar Phleboliths are ubiquitously seen in body parts with chronic venous thrombosis.2Bhat V. Bhat V. Shining Pearls sign: a new identity for venous malformations on computed tomographic imaging.Int J Angiol. 2016; 25: e21-e24Crossref PubMed Scopus (1) Google Scholar Phleboliths correlate with the presence of arteriovenous microshunts and are a marker of slow-flow venous malformation.3Hammer S. Zeman F. Fellner C. Wohlgemuth W.A. Uller W. Venous malformations: phleboliths correlate with the presence of arteriovenous microshunts.AJR Am J Roentgenol. 2018; 211: 1390-1396Crossref Scopus (7) Google Scholar The occurrence of arteriovenous microshunts in untreated venous malformations is a frequent phenomenon, and this hemodynamic subtype is significantly associated with phleboliths and large lesions.3Hammer S. Zeman F. Fellner C. Wohlgemuth W.A. Uller W. Venous malformations: phleboliths correlate with the presence of arteriovenous microshunts.AJR Am J Roentgenol. 2018; 211: 1390-1396Crossref Scopus (7) Google Scholar VMs of the extremities significantly affect quality of life of the patients owing to their appearance, pain, and injury risk. Although the clinical outcomes for localized VMs have been excellent, extensive VMs require multiple treatments to reduce symptom intensity. Study design, Writing, Editing, Drafting: Tanuja Rajial, Pradeep Kumar Gunasekaran, Lokesh Saini. Intellectual content: Lokesh Saini. Critical revision, Final approval: Tanuja Rajial, Pradeep Kumar Gunasekaran, Sujatha Manjunathan, Kuldeep Singh, Lokesh Saini. The Authors declares that there is no conflict of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.