Case Report
Spindle cell haemangioendothelioma in an arteriovenous fistula of the ring finger after blunt trauma

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Abstract

We present a case of traumatic arteriovenous fistula of the palm and ring finger, which posed management dilemmas and eventually necessitated ray amputation. Subsequent histology revealed a spindle cell haemangioendothelioma that had developed within the fistula. We report the clinical features and management of this patient.

Section snippets

Case report

A 22-year-old man sustained a crush injury to his left hand and ring finger. No demonstrable bony injury was found although a scaphoid fracture was suspected clinically. The hand was rested in a plaster splint for 2 weeks and mobilised after that time, when further imaging failed to demonstrate a fracture. However, on removal of the splint, the patient was noted to have an extremely swollen ring finger together with pulsatile veins in the hand and forearm, which were continuous with those

Discussion

Most AVF occur after penetrating trauma, fracture or dislocation.4 An artery and adjacent vein become disrupted and develop an abnormal communication with high flow and low resistance. AVF formation following blunt trauma is very rare. It has been postulated that arteries affected by atherosclerosis are more likely to develop AVF due to plaque rupture and vessel disruption.5 However, this patient was a healthy young male without any evidence of generalised vascular pathology.

SCH is a rare

References (9)

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Cited by (15)

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    The scoliosis may have been secondary to the abnormal rib growth, though this remains speculative because the tumor was imaged only after the patient turned 21 and became symptomatic. Although some previous adult cases of KHE manifesting in areas of previous trauma have been reported [5], and various forms of hemangioendothelioma have been observed in damaged tissues [7], there was no evidence that our patient had any history of chest wall trauma. Because KHE is rare, no treatment guidelines have been established for this disease.

  • A case of angioleiomyoma presenting as a pulsatile tumor in the left ring finger

    2011, Annals of Vascular Surgery
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    Most of these aneurysms were caused by chronic trauma from occupational or sports-related overuse.9,10 The reports of arteriovenous fistulas (AVFs) of the ring finger also include a history of blunt trauma and congenital AVF.11,12 This patient was misdiagnosed as having an AVF causing a local vascular dilatation, because the angiograms revealed venous drainage in the early phase, although this patient had no history of trauma.

  • Spindle cell hemangioma (hemangioendothelioma) of the head and neck: case report of an unusual (or underdiagnosed) tumor

    2008, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology
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    Fletcher et al.2 thought that the presence of clusters of abnormal vessels close to the tumor and a smooth muscle component within the tumor, as well as the association of some SCH with early varicosities, is indicative of a nonneoplastic and possibly reactive lesion. They proposed that SCH is caused by abnormalities of blood flow due to an arteriovenous shunt at the affected area, a view shared by some authors20 and disputed by others.11 Imayama et al.3 noticed that the endothelial cells in SCH present features indicative of deregulated angiogenesis, and the vessels have the ability to form different segments of the microvasculature.

  • Vascular lesions of the hand

    2005, European Journal of Radiology
  • Acquired arteriovenous fistulae

    2005, EMC - Cardiologie-Angeiologie
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This work has not been presented at any National or International meetings wholly or in part.

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