ARRS 2022 Abstracts

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E1391. Slow-Flow Retroperitoneal Venolymphatic Malformations: A Rare Entity
Authors
  1. Randy Chang; UCLA Medical Center
  2. Soni Chawla; Olive View-UCLA Medical Center
  3. Evan Raff; Olive View-UCLA Medical Center
Background
Lymphangiomas, also known as lymphangectasia or lymphoceles, are benign and most often seen in the head and neck region in children but rarely found within the abdomen: Retroperitoneal lymphangiomas make up about 1% of all lymphangiomas. There are limited reports of ovarian localization, with even fewer reports regarding paraovarian or gonadal vein lymphangiomas. The entity is often discovered incidentally, but patients may present with a palpable abdominal mass or be asymptomatic. Imaging provides important diagnostic information and helps to determine the appropriate management. This exhibit will give an overview of relevant gonadal anatomy. In addition, background will be provided for the different types of venolymphatic malformations (VLMs). Using a multimodal imaging approach, the exhibit will also present multiple examples of gonadal vein lymphangiomas with associated imaging findings to better help the radiologist identify these rare entities. Additional imaging examples of other types of VLMs will also be discussed.

Educational Goals / Teaching Points
This educational exhibit will provide examples of gonadal vein lymphangiomas. Using a multimodal imaging approach, it will present multiple cases that illustrate the key imaging findings of the non-emergent entity with associated imaging findings, including progressive enhancement and phleboliths. A brief overview of the relevant gonadal anatomy, different types of VLMs and corresponding imaging, and appropriate management, will also be included.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
It is important for the radiologist to be familiar with the different types of VLMs, including the radiologic manifestations of gonadal vein lymphangiomas, so that timely diagnostic workup and management can be initiated. The imaging findings of this rare entity include lobular shape, low attenuation and echogenicity, variable enhancement, associated phleboliths, and extension from the origin of the left renal vein to the left adnexa along the left gonadal vein.

Conclusion
The diagnosis of VLMs, including gonadal vein lymphangiomas, is challenging. Reviewing the common imaging findings of gonadal vein lymphangiomas using multiple modalities and understanding the corresponding appropriate management can significantly help the physician to better treat patients.