Vascular Anomalies in the Posterior Neck

Diagnostic Imaging

MRI of the neck without and with IV contrast is the most appropriate next imaging study to fully characterize vascular lesions and determine their extent, vascular nature, and relationship to surrounding structures, as recommended by the American College of Radiology 1, 2, 3
Contrast-enhanced MRI aids in identification of vascular architecture, areas of enhancement, and extent of the lesion, according to the American College of Radiology 1, 2
Non-contrast MRI has the highest sensitivity for detecting soft tissue edema, fluid collections, and anatomic relationships, as stated by the American College of Radiology 1, 5
Identifying vascular components, feeding vessels, and draining veins is essential for guiding treatment decisions, as noted by the American College of Radiology 2, 4
Delineating vascular involvement and relationship to critical neurovascular structures is crucial for treatment planning, as recommended by the American College of Radiology 1

Vascular malformation (venous, lymphatic, or combined) is a possible diagnosis given the subcutaneous location and vascular appearance, according to the American College of Radiology 3
Soft tissue gas from infection, such as necrotizing fasciitis, must be excluded, particularly in the presence of systemic symptoms, as warned by the American College of Radiology 6, 1, 5
Hemangioma or other vascular tumor is a less likely diagnosis in adults but possible, as noted by the American College of Radiology 3, 7

Duplex Doppler ultrasound can be performed as a complementary study to distinguish between high-flow and low-flow vascular malformations, as recommended by the American College of Radiology 4
CT angiography (CTA) of the neck with IV contrast may be appropriate if MRI is contraindicated or urgent evaluation is needed, as stated by the American College of Radiology 8, 2

Signs of infection, such as fever, erythema, warmth, rapid progression, and systemic toxicity, must be assessed urgently, as recommended by the American College of Radiology 6, 1
Pain severity and rapidity of onset, as well as neurological symptoms suggesting vascular compromise, must be evaluated, as noted by the American College of Radiology 6, 8, 2
Bleeding or pulsatile characteristics suggesting high-flow lesion must be assessed, as warned by the American College of Radiology 8