Outflow-Restricted Developmental Venous Anomaly Masquerading as a Tumefactive Lesion on Imaging

Area of Science:

• Neurology
• Radiology
• Vascular Malformations

Background:

• Developmental venous anomalies (DVA) are congenital vascular malformations typically found incidentally.
• Symptomatic presentation of DVAs is uncommon, with most cases being asymptomatic.

Observation:

• A rare case of a developmental venous anomaly with restricted outflow presented with new-onset seizures.
• Initial neuroimaging revealed expansile signal changes mimicking a neoplasm due to hemorrhagic venous infarction.

Findings:

• The patient experienced seizures attributed to an outflow-restricted DVA.
• Hemorrhagic venous infarction in the DVA's draining territory presented as a mass lesion.
• Follow-up imaging demonstrated regression of the mass effect and asymptomatic thrombosis in a separate vein.

Implications:

• Atypical imaging findings in the draining territory of a DVA should prompt consideration of outflow restriction.
• This case underscores the importance of recognizing DVAs as a potential cause of neurological symptoms beyond typical presentations.
• Early identification of outflow restriction in DVAs is crucial for appropriate management and preventing complications like venous infarction.