PMC4329693_01
On general examination, there are. (A) swellings in the anterior abdominal wall (asterisk) (B) swellings over the back (long white arrow) (C) flat foot (short white arrow) (D) wide gap in between the first and second toes (black arrow)
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F1
A 16-year-old boy presented with swellings in the anterior abdominal wall of both lumbar regions [Figure 1A]. There was also a large swelling over the back of left shoulder [Figure 1B]. General examination revealed flat foot [Figure 1A and C] wide gap between the first and second toes [Figure 1D] bilaterally.
(A) Radiographs of the feet show widened space between the first and second toes and bilateral flat foot (white arrow) (B) USG and color Doppler images showing venous malformation (Asterisk)
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F2
Radiographs of both feet also confirmed the widened interspace between the first and second toes and the flat foot [Figure 2A]. USG doppler of the anterior abdominal wall showed dilated venous spaces in the subcutaneous plane [Figure 2B].
(A and B) MRI-T2 STIR axial sections showed multiple heterogeneous high signal foci in the anterior abdominal wall (asterisk) (C) T2 coronal section showed scoliosis of the thoracic spine (arrow)
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F3
MRI showed heterogeneous high signal in the anterior abdominal wall [Figure 3A and B] and in the paraspinal region [Figure 3C]. There was asymmetric increased fat deposition in the posterior abdominal wall [Figure 3A and B]. MRI also confirmed the scoliosis with apex to the right [Figure 3C].
Sclerotherapy for the right anterior abdominal wall swelling. Black arrow points to venous channels filling with contrast. White arrow shows sclerosant filling the venous channels
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F4
Approximately 3 ml of sodium tetradecyl sulfate was injected into the right anterior abdominal wall swelling [Figure 4].