In addition, the presence of phleboliths
in hemangiomas can also be mistaken for sialolithiasis.
Intramuscular VMs are more likely to present with phleboliths
than malformations of similar size not involving muscle.
Differentiation between calculi and phleboliths
on plain x ray films often poses difficulty but this can be verified on intravenous urography studies where calculi fall in line of the renal system whereas phleboliths
fall outside the line of kidney and urinary bladder.
Furthermore, they have homogenous enhancement and do not contain phleboliths
. Venous malformations are T1 isointense to muscle, T2 hyperintense and do not demonstrate flow voids as in our patient.
Submandibular gland cavernous hemangioma with phlebolith
masquerading as sialadenitis.
On ultrasonography they are seen as heterogenous, hypoechoic lesions which may or may not have phleboliths
. Computed Tomography (CT) scan reveals tumour as enhancing mass similar to the blood vessels.
Imaging Characteristics of Common Vascular Anomalies Lesion Morphology Enhancement T2 signal Hemangioma Lobular, ++ + (Phase 1) hypervascular VM Trans-spatial, ++ ++ common phleboliths
LM Large cystic spaces - ++ (macrocystic) LM Multiseptated; very +/- + (microcystic) small cystic spaces AVM Vascular flow voids + + without discrete mass Lesion Comments Hemangioma Only moderately increased T2 signal (Phase 1) reflects hypercellularity VM High T2 signal reflects low cellularity LM Image like cysts; hemorrhagic fluid levels (macrocystic) common LM Low fluid content; may appear solid (microcystic) AVM Hyperperfusion results in tissue edema Table 4.
But Kaposi's sarcoma rarely contains cavernous vessels with thrombi and phleboliths
and lacks epithelioid cells, and their spindle cells react for the endothelial marker CD34.
The patient presented here has the spindle cell type, which is much more specific for Maffucci syndrome (12) and comprised of cavernous vascular spaces with organized thrombi and phleboliths
. These cavernous spaces are unencapsulated, largely dilated blood vessels that are separated by very little connective tissue.
KUB cannot visualize radiolucent calculi (10-20% of calculi) and overlying bowel gas, faecoliths, and phleboliths
can make interpretation difficult .
These structures included calcifications of arteries, lymph nodes and salivary glands, phleboliths
, an elongated styloid process, a large maxillary tuberosity, a prominent hamulus of the pterygoid process, foreign bodies, bone islands in the mandibular rami, and a displaced tooth [4, 6, 7, 10, 13, 17, 18].
There were multiple phleboliths
suggesting venous hemangioma.