Mahmoud Hsairi, Achraf Saidi, Samia Amar, Ayman El Farouki, Rachida Saouab
Journal: Medpeer Publisher
ISSN: 3066-2737
Volume: 3
Issue: 9
Date of Publication: 2026/09/08
Background. Peripheral arteriovenous malformations (AVMs) are rare congenital high-flow vascular lesions defined by a direct arteriovenous shunt lacking an intervening capillary bed. Misdiagnosis or inappropriate management may lead to catastrophic haemorrhage, high-output cardiac failure, trophic ulceration and functional loss of the limb. The angiographic Cho–Do–Yakes classification directly determines the endovascular strategy.
Case presentation. A patient was referred for imaging evaluation of a slowly enlarging, pulsatile swelling of the distal third of the right arm. Clinical examination revealed a palpable thrill, local warmth, a continuous systolo-diastolic bruit and dilated tortuous superficial veins, with mildly diminished ipsilateral distal pulses suggesting a moderate steal phenomenon (Schöbinger stage II). Triphasic CT angiography demonstrated a bulky dysplastic soft-tissue vascular network measuring 107 × 46 mm, organised around a complex nidus, fed predominantly by the distal brachial artery, with early venous opacification during the arterial phase through two dominant outflow axes — the cephalic vein and the ulnar venous network. Multiple intralesional phleboliths were present, without cortical erosion or medullary involvement of the distal humerus. The lesion was classified as Cho type IIIb.
Conclusion. This case illustrates the diagnostic power of multiphasic CT angiography in mapping a high-flow AVM and the necessity of rigorous classification to guide endovascular therapy. A painless, slowly progressive upper-limb mass may harbour a potentially devastating high-flow shunt whose control relies on the combined expertise of the diagnostic radiologist, the interventional radiologist and the vascular surgeon.
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Arteriovenous malformation; Peripheral AVM; Cho classification; ISSVA classification; Nidus; CT angiography; Embolization; High-flow shunt; Schöbinger staging
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