PMC4835636_01
Ultrasonography of the small bowel of a three-year-old girl presenting with anemia. A, 2D gray-scale image depicting bowel wall thickening with multiple cystic locules (arrows). The bowel lumen (L) was patent; B, Pseudo-flow artifact was provoked when the lesion was compressed by a sonographic probe; C, Oblique coronal reformatted arterial phase computed tomography (CT) image showing segmental bowel wall thickening involving the middle layer of the jejunum (arrows); D, Portovenous phase CT image revealing the multifocal contrast-filling spaces at the thickened bowel wall (arrowheads); E and F, CT angiography with maximum intensity projection (MIP) images showing no engorged mesenteric vessel on arterial and portovenous phases. Note the contrast filling spaces on portovenous phase (arrowheads).
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Numerous cystic locules that did not exceed 1 cm in diameter were identified in the thickened bowel wall (Figure 1A). Pseudo-flow artifact was present when the lesion was compressed by the US probe (Figure 1B). An arterial phase CT image (Figure 1C) showed circumferential, low attenuation bowel wall thickening involving the jejunum, and its extent was more than 10 cm in length. In portovenous phase CT image (Figure 1D) (Figure 1D), multifocal punctate and curvilinear areas of enhancements were presented in the middle layer of the thickened bowel wall, which showed low attenuation in the arterial phase. No engorged feeding artery or early draining vein was demonstrated on the maximum intensity projection image on the arterial phase (Figure 1E) but enhancement of the thickened bowel segment was appeared on the portovenous phase of CT image (Figure 1F).
Intraoperative photograph and microscopic examination. A, Intraoperative photograph image showing the dark red and purple berry-like vascular malformation encircling the jejunum; B, Hematoxylin and eosin (H&E), 20 x magnified image showing multiple dilated vascular structures of variable sizes and the thickness of the wall affecting the bowel submucosa, muscularis propria, and subserosa.
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The mass involved 13 cm of the mid jejunum and the lesion consisted of multiple cystic locules containing old blood (Figure 2A). Single or multiple endothelial layers lined the wall of the dilated venous structures (Figure 2B) and these findings were consistent with arteriovenous malformation.