Diagnosis and conservative treatment of a rare case of femoral intraosseous arteriovenous malformation in a patient with polyostotic fibrous dysplasia: A case report

Ohshika,Shusa; Yanagisawa,Michiro; Tsushima,Fumiyasu; Ishibashi,Yasuyuki

doi:10.3892/mco.2019.1845

Diagnosis and conservative treatment of a rare case of femoral intraosseous arteriovenous malformation in a patient with polyostotic fibrous dysplasia: A case report

Authors:
- Shusa Ohshika
- Michiro Yanagisawa
- Fumiyasu Tsushima
- Yasuyuki Ishibashi
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Affiliations: Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori 036‑8562, Japan, Department of Radiology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori 036‑8562, Japan
Published online on: April 16, 2019 https://doi.org/10.3892/mco.2019.1845
Pages: 587-591
Copyright: © Ohshika et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Pure intraosseous arteriovenous malformation (AVM) in a limb bone is extremely rare. Furthermore, there is currently insufficient information on the diagnostic and therapeutic strategies for pure intraosseous AVMs. We herein report a case of pure intraosseous AVM of the proximal femur occurring in a patient with polyostotic fibrous dysplasia. The patient was a 39‑year‑old woman who presented with pain in the right thigh. Plain radiographs and computed tomography scans revealed a medullary lytic lesion with expansion and thinning of the bone cortex in the right proximal femur, mimicking a primary bone tumor. Magnetic resonance imaging (MRI) examination revealed intramedullary signal voids and feeding arteries arising from the deep femoral artery. A non‑surgical approach using embolization and denosumab achieved satisfactory results, which included complete obliteration of the AVM, increased cortical thickness of the right proximal femur, and attenuation of the high‑turnover bone metabolism 1 year later. Careful review of MRI images is crucial for distinguishing between bone tumors and intraosseous AVM, which exhibit signal voids and feeding arteries, in order to avoid unnecessary interventions such as bone biopsy or surgery.

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