Reason: 13 yo with Klippel Trenaunay malformation of left buttock, thigh, lower leg. ?Macrocysts v microcystic, ?persistent embryonic vein of Servelle, ?normal deep venous system - please evaluate. History: Multiple prior procedures to debulk, repeated episodes of cellulitis There is a complex capillary-lymphaticovenous malformation in the right lower extremity extending from the level of the right hip joint to the proximal tibia (approximately 12 cm below the mean). There also appears to be extension proximally into the retroperitoneum. This results in asymmetric enlargement of the right lower extremity as well as multifocal muscular atrophy, most markedly the right gluteal musculature. The malformation is predominantly microcystic in appearance. Several focal superficial varicosities are identified (series 5, image 14). There is no significant enhancement observed on postcontrast imaging. An abnormal lateral marginal vein is not observed. The normal femoral artery and vein as well as the deep and superficial femoral vessels are patent with a normal configuration. The right pelvic veins and multiple superficial veins in the lower extremity are enlarged and tortuous. Oval, circumscribed lesion in the neurovascular bundle between the semitendinosus and semimembranosus in the distal femur measures 1.7 x 1.1 cm with T1 hyperintensity and T2 hypointensity, indicative of blood products and a possible draining vein, which may reflect a partially thrombosed AVF.There is a right hydrocele, which is likely secondary to poor venous/lymphatic drainage on the right. The bladder is distended, but appears normal. Mildly prominent inguinal lymph nodes are nonspecific. The known leg length discrepancy is not well evaluated on this study.
1.Complex capillary lymphaticovenous malformation of the right pelvis and lower extremity, predominantly microcystic.2.An abnormal lateral marginal vein is not identified.3.There is a normal deep venous system in the thigh but multiple enlarged and tortuous superficial vessels are also present in the pelvis and lower extremity.4.Possible partially thrombosed AVF in the neurovascular bundle of the posterior distal right thigh.