JRCR - Journal of Radiology Case Reports JRCR - Journal of Radiology Case Reports
Discussion started by Charles Yang 3 weeks ago

Dear JRCR editor(s):


 


We hope you will consider the following case as suitable for submission to the JRCR:


Case report: 40 year old healthy female presents from an outside facility for evaluation of a progressively, slowly enlarging subcutaneous, left zygoma mass. She first noticed the mass 6 months prior to presentation stating that at that time it felt the size of a “small pimple” beneath the skin. She believes it has slowly increased in size. Patient denies pain, but feels uncomfortable especially when her sunglasses sit on the mass. No prior history of trauma or cancer. No medical or surgical history. Full review of systems is unremarkable. On exam there is a palpable, sub-cutaneous, 1 centimeter, non-mobile, mildly tender, firm mass inferolateral to the left orbital rim on the zygoma. There are no overlying skin changes. No other head and neck lesions or masses. The patient arrived with a non-contrast CT and a PET/CT performed by the referring institution. Differential diagnosis after clinical evaluation consisted of osteoid osteoma, fibrous dysplasia, osteochondroma, or ossifying fibroma. The patient elected to proceed with surgical biopsy. Access to the mass was achieved with an upper gingiva buccal incision and incisional curettage biopsy of the mass was followed by bony bleeding which was controlled with Bone Wax, Ethicon (Somerville, NJ, USA). Final pathology resulted as intraosseous venous malformation


Intraosseous venous malformations of the zygoma are exceptionally rare and frequently the diagnosis is not made until after surgical pathology. A sunburst trabeculae pattern on computed tomography is pathognomonic for this lesion and special attention to the preoperative imaging findings and surgical hemostasis is necessary to avoid complications from resection of these exceedingly rare and highly vascular lesions.


 


Charles Yang


 


 

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