Abstract No. 533 Percutaneous Sclerotherapy of Lower Body Lymphatic Malformations with Intraosseous Involvement: A Report of Three Cases

Lymphatic malformations (LMs) with intraosseous involvement are uncommon vascular anomalies with limited literature. This study aims to describe three patients treated for intraosseous lymphatic malformations in the lower body. We performed a retrospective review of all patients at our institution treated with percutaneous sclerotherapy from 01/2003 to 08/2023 for intraosseous LMs. We identified three cases, and collected data on demographics, clinical presentation, treatment, adverse events, and clinical response. We identified three non-Hispanic white patients treated for intraosseous lymphatic malformations. Their symptoms, which began between ages 10 and 18, included pain, weakness and swelling. Patient 1 (age 17): LM in the distal left femoral metadiaphysis treated with a single embolization using 30 units of bleomycin foam. Two sites were accessed under fluoroscopic guidance, general anesthesia, and nerve monitoring. Patient reported average pain as 4/10 and worst pain as 8/10 prior to treatment; no pain following treatment. Patient 2 (age 19): LM in the right femur treated with two embolizations using doxycycline (26 cc; 39 cc). For both procedures, 3 sites were accessed under sonographic and fluoroscopic guidance, general anesthesia, and without nerve monitoring. Average pain was 7/10 prior to treatment; post-treatment, the average pain was 4-5/10 and worst pain was 8/10, although frequency and duration of pain decreased. Patient 3 (age 56): LM in the right iliac crest and overlying soft tissue. The intraosseous component was treated with five embolizations using a combination of methodologies and agents (Table 533.1). All procedures were performed under general anesthesia with no nerve monitoring. Average pain was 1-2/10 and worst pain was 4/10 prior to treatment, with significant dysmotility; no pain or dysmotility was reported after treatment. No patient reported intraoperative complications, skin burns, or nerve damage following treatment. Percutaneous sclerotherapy is potentially a safe and effective treatment for lower-body lymphatic malformations with intraosseous involvement.