PMC4860454_01
39-year-old female with a 24-year history of a lesion affecting the left nondominant hand diagnosed as a congenital arteriovenous malformation of the left hand and wrist. (a) Photograph of the hand shows the arteriovenous malformation visibly involves the radial aspect of the palm and index finger and (b) digital subtraction angiography confirms a Type-A arteriovenous malformation of the radial artery, palmar arch, and digital arteries of the index and middle fingers. There is minimal contrast agent seen in the thumb, ring or little finger digital arteries (black arrow). (c) Thermal image of the arteriovenous malformation shows distal vascular "steal" affecting the thumb, ring and little fingers (white arrows), and (d) thermal image of the unaffected right hand for comparison.
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F1
On examination, an extensive vascular anomaly was noted to involve the palm, index and middle fingers, and distal forearm and wrist [Figure 1a], with bruit and a palpable thrill. An ultrasound Doppler scan and magnetic resonance angiography confirmed the diagnosis of a high-flow AVM, and digital subtraction angiography was used to define the anatomy of the malformation and shows features of a Type-A AVM [Figure 1b]. Baseline images of the affected [Figure 1c] and unaffected hand [Figure 1d] were recorded for future monitoring of the AVM with regards to progression of the lesion or of the steal phenomenon.