PMC3056373_01
Orthopantomogram shows a large expansile osteolytic lesion (arrows) involving both sides of the body of the mandible
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An orthopantomogram [Figure 1] showed a large, well-defined, osteolytic lesion with sclerotic margins within the body of the mandible.
Axial, non-enhanced CT scan shows the expansile and osteolytic nature of the lesion, with hyperdense areas within (arrows) signifying partial thrombosis
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A CT scan confirmed the presence of an expansile osteolytic lesion involving the body of the mandible [Figure 2], with enhancement of the lesion.
Axial (A) and sagittal (B) contrast enhanced T1W MR images show the arteriovenous malformation (AVM) (arrows) involving the whole of the body of the mandible
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MRI studies were also carried out [Figure3A and B].
Lateral DSA image shows venous drainage of the AVM (long arrow) into the left internal jugular vein (short arrow)
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Digital subtraction angiography demonstrated a large AVM within the body of the mandible supplied by branches of both external carotid arteries and draining via a large intraosseous venous sac into the left internal jugular vein [Figure 4].
Lateral representative DSA image, of the left external carotid artery shows the embolized branch of the lingual artery seen as a glue-cast (straight arrow) and a hypertrophied anterior branch (curved arrow) from the terminal external carotid artery, supplying the AVM.
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B. Braun, Germany) was injected [Figure 5].
Frontal (A) and lateral (B) post-embolization radiographs after direct percutaneous glue injection show complete filling of the AVM (arrow) in the mandible with a mixture of N-butyl cyanoacrylate glue and radioopaque contrast agent (Lipiodol)
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Three milliliters of 20% Histoacryl glue was injected through this needle using fluoroscopic guidance [Figure 6].
Post-embolisation T2W axial (A) and coronal (B) MRI images show thrombosis (arrow) of the AVM in the mandible and the absence of flow voids
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An MRI scan of the mandible performed a few days later showed thrombosis within the vascular spaces of the AVM [Figure 7].