PMC9104120_01
The anterior view and the posterior view of the patient. (A,B) The image showed innumerable masses spread throughout her body and mainly concentrated on the face, neck, bilateral upper limbs, and trunk.
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F1
Physical examination demonstrated multiple subcutaneous masses in different sizes and CALMs scattered all over the body (Figure 1).
Cranial T2-weighted magnetic resonance imaging. (A) Sagittal plane of the neck; (B,C) the coronal plane of the neck; and (D) horizontal plane of the neck.
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F2
Arteriovenous malformations, neoplastic dilatation, and thrombosis were observed on the left side of the neck, also, a few blood vessels were found to protrude into the spinal canal to compress the cervical spinal cord (Figure 2).
Figures of preoperative three-dimensional computerized tomography. (A) The anterior view of the three-dimensional CT of vertebral arteriography; (B) The left view of the three-dimensional CT of vertebral arteriography; (C) The post view of the three-dimensional CT of vertebral arteriography; (D) Three-dimensional reconstruction of the left neck.
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F3
It revealed the left vertebral artery-internal jugular vein-spinal vein fistula (Figure 3).
Figures of digital subtraction angiography. (A) Angiography showed a large area of the left vertebral artery; (B) Brachiocephalic trunk angiography showed a large flow of blood from the right vertebral artery through a circle of Willis to the left; (C) Posterior-anterior image of left vertebral arteriogram; (D) Lateral image of left vertebral arteriogram.
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F4
Vertebral angiography showed a dilated left vertebral vein at the later stage of the artery, and hence, an arteriovenous fistula was considered (Figure 4).
Pictures of the procedure. (A) Angiography showed massive venous development before embolization; (B) Angiographic image after coil embolization; (C) Angiography showed good occlusion and less vein development after coil embolization.
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F5
Before embolization, the angiogram showed multiple fistulas (Figure 5A) and three 8-12 double-plug spring coils. One 8 mm x 20 cm controllable spring coil and another 6 mm x 20 cm controllable spring coil [Axium MicroFX Coils (ev3; Plymouth, Minnesota, USA)] were applied to the main part of the fistula (Figure 5B). During the angiography, post-placement of the spring coils revealed significant occlusion, and vein development was greatly reduced compared to before (Figure 5C).