Ultrasound-guided sclerotherapy for a pyogenic granuloma associated with an arteriovenous malformation: a case report

Willian Gabriell de Matos Araújo  Moraes; Arianne Kimberly Barbosa da Matta; Luis Otávio Pereira da Silva; Wagner Henriques de Castro; Silvia Ferreira de Sousa; Tarcília Aparecida Silva; Maurício Augusto Aquino de Castro; Ricardo Alves Mesquita

doi:10.5327/2525-5711.527

Authors

Willian Gabriell de Matos Araújo Moraes Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil https://orcid.org/0000-0002-5545-1795
Arianne Kimberly Barbosa da Matta Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil https://orcid.org/0000-0003-0039-9560
Luis Otávio Pereira da Silva Faculdade de Odontologia da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. https://orcid.org/0009-0000-3125-2938
Wagner Henriques de Castro Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil https://orcid.org/0000-0003-2745-2878
Silvia Ferreira de Sousa Faculdade de Odontologia da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. https://orcid.org/0000-0001-7820-4749
Tarcília Aparecida Silva Faculdade de Odontologia da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. https://orcid.org/0000-0001-9623-7835
Maurício Augusto Aquino de Castro Faculdade de Odontologia da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. https://orcid.org/0000-0001-6013-9344
Ricardo Alves Mesquita Faculdade de Odontologia da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. https://orcid.org/0000-0003-3207-4007

DOI:

https://doi.org/10.5327/2525-5711.527

Keywords:

Arteriovenous Malformations, Vascular anomalies, Pyogenic Granuloma, Sclerotherapy, Polidocanol, Ultrasonography

Abstract

Vascular anomalies (VAs) are congenital developmental disorders associated with morbidity and aesthetic impairment. Pyogenic granuloma (PG) developing over arteriovenous malformations (AVM) is uncommon and lacks well-defined management protocols. An 84-year-old male presented with a large PG on the lower lip following chemical trauma, arising over an AVM confirmed by color Doppler ultrasonography. Ultrasound-guided sclerotherapy with 3% polidocanol was performed, resulting in complete remission of both lesions after four sessions (60 days). Residual pediculated fibrotic tissue was managed by base ligation. No recurrence was observed at five-month follow-up. The association of PG with AVM is rare and may influence the therapeutic approach. Doppler ultrasonography enabled identification of a fast-flow AVM and guided treatment. Sclerotherapy with polidocanol minimized hemorrhagic risk and resulted in satisfactory healing without complications. Ultrasound-guided sclerotherapy appears to be a safe and effective minimally invasive treatment for VAs in the orofacial region.

References

1. Ng AT, Tower RL, Drolet BA. Targeted treatment of vascular anomalies. Int J Womens Dermatol. 2021;7(5PA):636–9. doi:10.1016/j.ijwd.2021.10.014

2. Kunimoto K, Yamamoto Y, Jinnin M. ISSVA classification of vascular anomalies and molecular biology. Int J Mol Sci. 2022;23(4):2358. doi:10.3390/ijms23042358

3. International Society for the Study of Vascular Anomalies. ISSVA classification of vascular anomalies. 2025. Available from: https://www.issva.org/classification

4. Seront E, Queisser A, Boon LM, Vikkula M. Molecular landscape and classification of vascular anomalies. Hematology. 2024;2024(1):700–8. doi:10.1182/hematology.2024000598

5. Lomeli Martinez SM, Carrillo Contreras NG, Gómez Sandoval JR, Zepeda Nuño JS, Gomez Mireles JC, Varela Hernández JJ, et al. Oral pyogenic granuloma: a narrative review. Int J Mol Sci. 2023;24(23):16885. doi:10.3390/ijms242316885

6. Kaleeny JD, Janis JE. Pyogenic granuloma diagnosis and management: a practical review. Plast Reconstr Surg Glob Open. 2024;12(9):e6160. doi:10.1097/GOX.0000000000006160

7. Plachouri KM, Georgiou S. Therapeutic approaches to pyogenic granuloma: an updated review. Int J Dermatol. 2019;58(6):642–8. doi:10.1111/ijd.14268

8. Garzon MC, Enjolras O, Frieden IJ. Vascular tumors and vascular malformations: evidence for an association. J Am Acad Dermatol. 2000;42(2 Pt 1):275–9. doi:10.1016/S0190-9622(00)90138-5

9. Rancan A, Boscarelli A, Codrich D, Berti I, Guida E, Schleef J. Pyogenic granuloma arising within capillary malformations in children: a case report and literature review. Dermatol Rep. 2021;13(2):9115. doi:10.4081/dr.2021.9115

10. Fernandez-Vazquez J, Del Pozo Losada J, Sacristán-Lista F. Pyogenic granuloma over the venous component of a mixed vascular malformation. J Cutan Pathol. 2019;46(5):368–71. doi:10.1111/cup.13429

11. Bagga B, Goyal A, Das A, Bhalla AS, Kandasamy D, Singhal M, et al. Clinicoradiologic predictors of sclerotherapy response in low-flow vascular malformations. J Vasc Surg Venous Lymphat Disord. 2021;9(1):209–19. doi:10.1016/j.jvsv.2020.03.011

12. Queisser A, Seront E, Boon LM, Vikkula M. Genetic basis and therapies for vascular anomalies. Circ Res. 2021;129(1):155–73. doi:10.1161/circresaha.121.318145

13. Léauté-Labrèze C. Medical management of vascular anomalies of the head and neck. J Oral Pathol Med. 2022;51(10):837–43. doi:10.1111/jop.13324

14. Eyuboglu AA, Isken TM, Demir A, Kurklu M. Laser-assisted vascular malformation resection: a novel surgical approach. J Cutan Aesthet Surg. 2023;16(2):149–51. doi:10.4103/JCAS.JCAS_9_22

15. Luna-Ceron E, Gómez-Gutiérrez AK, Gonzalez-Hernandez C, Gatica-Torres M. An uncommon presentation of pyogenic granuloma. Cureus. 2021;13(1):e12620. doi:10.7759/cureus.12509

16. Elbarbary M, Sgro A, Khazaei S, Goldberg M, Tenenbaum HC, Azarpazhooh A. The applications of ultrasound, and ultrasonography in dentistry: a scoping review of the literature. Clin Oral Investig. 2022;26(3):2299-316. doi: 10.1007/s00784-021-04340-6

17. Fiore M, Bortoli M, Sambri A, Lotrecchiano L, Lovato L, Mirelli M, et al. Soft tissue vascular anomalies of the extremities: a proposed diagnostic approach. Life. 2024;14(6):670. doi: 10.3390/life14060670

18. Prajapat J, Prajapat R, Khanagar SB, Siddeeqh S. Extragingival pyogenic granuloma of the lower lip masquerading as a vascular lesion. J Oral Maxillofac Pathol. 2022;26(Suppl 1):S119–23. doi:10.4103/jomfp.jomfp_108_21

19. Esposito F, Ferrara D, di Serafino M, Diplomatico M, Vezzali N, Giugliano AM, et al. Classification and ultrasound findings of vascular anomalies in pediatric age: the essential. J Ultrasound. 2019;22:13–25. doi: 10.1007/s40477-018-0342-1

20. Deshpande AJ, Dubey VC. 3% polidocanol sclerotherapy for pyogenic granuloma: efficacy and safety analysis. J Cutan Aesthet Surg. 2022;15(3):284–7. doi:10.4103/JCAS.JCAS_119_21

21. Fukuzawa S, Yamagata K, Okubo-Sato M, Terada K, Uchida F, Ishibashi-Kanno N, et al. Therapeutic effect of polidocanol sclerotherapy on oral vascular malformations. Dent J (Basel). 2021;9(10):119. doi:10.3390/dj9100119

22. Sharma S, Shah JS, Asrani VK, Verma A. The sclerotherapy-an efficacious approach in the management of vascular lesions and pyogenic granuloma: case series with literature review. Indian J Otolaryngol Head Neck Surg. 2021;73(2):167–73. doi:10.1007/s12070-020-01960-4

23. Majumdar B, Jain A, Bala S, Bandyopadhyay A, Singh A, Ghosh A. Recurrent pyogenic granulomas with underlying arteriovenous malformation: an exclusively rare entity. Indian J. Dermatol. 2015;60(4):423. doi:10.4103/0019-5154.160538

24. Hung CH, Kuo HW, Chiu YK, Huang PH. Intravascular pyogenic granuloma arising in an acquired arteriovenous malformation: report of a case and review of the literature. Dermatol Surg. 2004;30(7):1050-3. doi:10.1111/j.1524-4725.2004.30316.x