Shining Pearls Sign: A New Identity for Venous Malformations on Computed Tomographic Imaging

Vascular malformations, in particular venous malformations (VM), are common lesions involving the pediatric and adolescent population. VM occur at approximately 1:5,000 to 10,000; approximately 40% of them occur in the head and neck regions. Classical appearance of VM on imaging is a demonstration of near-normal-sized or mildly dilated feeding arteries which subsequently lead to dilated venous structures of varying caliber, thus constituting the malformation. Phleboliths are the hallmark of VM. Plain radiography has been an established modality for demonstrating phleboliths. The emergence of computed tomographic (CT) as a preferred imaging modality for the evaluation of a complex vascular malformation necessitates familiarity with the spectrum of CT appearances of this lesion. This presentation illustrates an additional CT sign, "shining pearls sign," highlighting the striking display of phleboliths in the vascular malformations, prompting correct diagnosis.