gms | German Medical Science

Objectives/Interrogation: Acquired digital arteriovenous malformation is a rare vascular anomaly usually involving the fingertip or periungual region.

We report three cases of acquired vascular malformation on fingertip of 3 adults.

Methods: Case 1: A 48-year-old lady presented with a vascular lesion on the left ring finger pulp that has been present for one year. No history of trauma. Recent recurrent bright red pulsating bleeding following minor trauma was reported. Examination revealed 5 mm purplish skin on the ulnar border of the pulp which did not reduce in size with elevation. Ultrasound scan showed 2mm subcutaneous lesion surrounded superficially by prominent vascularity. The appearance was in keeping with vascular malformation. Fingertip was explored and small lesion with overlying skin ellipse were biopsied. A small group of vessels at the base were cauterized. Histopathology showed proliferation of capillary channels with a bland of endothelial lining which confirmed the diagnosis of capillary hemangioma.

Case 2: A 55-year-old lady presented with a few-year history of a vascular lesion on her left ring fingertip without previous trauma. This was previously cauterized by dermatologists, recurred and started to bleed repeatedly over the last year. Examination revealed bluish compressible lesion on the radial border of the pulp. Doppler scan showed 1cm longitudinal subcutaneous lesion with increased venous vascularity. There was prominent flow but no feeding vessel or direct communication with digital vessels. These findings were consistent with hemangioma. Pulp was explored and general oozing with no obvious leash of vessels was found. Vessels in the base were cauterized and the wound was closed directly. 3 months postoperatively, patient reported no further bleeding.

Case 3: A 69-year-old retired right handed lady presented with 10-year history of a small vascular lesion on the tip of her right ring finger following minor trauma without open wounds. The lesion started recently to bleed with minimal trauma. Examination revealed 8X4mm capillary venous malformation. Treatment options were discussed and patient preferred having the base of the lesion cauterized without excising the overlying skin.

Results and Conclusions: Acquired digital arteriovenous malformations are rare acral vascular lesions that can involve fingertips usually with history of previous trauma. Treatment ranges from observing asymptomatic cases to complete excision of symptomatic lesions with or without local flap or skin graft reconstruction.