Fact-sheet: Veinous malformation - cavernous hemangioma


Updated on 03/09/2026 at 10:45 AM

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Definition

Belongs to the family of low-flow vascular malformations.
Corresponds to dysplastic veins, ectasias, or true venous lakes lined by endothelium.
Congenital, it may progress in flare-ups and typically worsens over the course of a lifetime.
Clinical diagnosis is straightforward in superficial forms.

Clinical features

Limbs 40%, cervicofacial 40%, trunk 20%. Superficial: (easy diagnosis) Bluish, painless, compressible nodule that increases in size with the Valsalva maneuver or with limb dependency. Deep: intramuscular, pain and mass effect. Progresses in painful flare-ups, notably with hormonal changes, deep muscular involvement, or intra-articular involvement

Laboratory findings

Nothing notable

Radiography

Mass syndrome.
The presence of phleboliths is pathognomonic of venous malformation.
Occasionally, contiguous bone erosion may be seen in large lesions.

Ultrasound

Poorly defined, lacunar, hypoechoic, heterogeneous mass.
Phleboliths with posterior acoustic shadowing.
Slow monophasic Doppler flow in 80% of cases.
No flow detected in 15%.
Occasionally biphasic flow (5%) when associated with a capillary malformation component

CT

Of limited value.
Mass syndrome.
More sensitive for detection of phleboliths and assessment of bone involvement in large lesions.
Nonspecific ring enhancement

MRI

Reference examination

  • Heterogeneous T2 fat-sat hyperintensity with fine septa, thrombi and phleboliths appearing hypointense.
  • Generally heterogeneous, isointense on T1.
  • T2 gradient echo: signal void in areas of slow flow (thrombus)
  • Post-gadolinium T1 fat-sat: enhancement in areas of T2 hyperintensity.

Management

Treatment if symptomatic or cosmetically bothersome:

  • Elastic compression and antiplatelet agents
  • Percutaneous sclerotherapy for deep intramuscular lesions or those with joint involvement, sometimes completed by surgical resection

Differential diagnosis

Diagnosis is sometimes difficult due to borderline forms with other slow-flow vascular malformations where several components coexist.
Lymphatic malformations in their macrocystic form (+/- hemorrhagic)

Hemangioma (vascular tumor): mass with fast arterialized flow on Doppler

Arteriovenous malformation: arterial flow on Doppler