Developmental Venous Anomaly

KEY FACTS

TERMINOLOGY

• Congenital cerebral vascular malformation with mature

venous elements

• May represent anatomic variant of otherwise normal

venous drainage

IMAGING

• General features

○ Umbrella-like collection of enlarged medullary (white

matter) veins ("Medusa head")

○ At angle of ventricle

○ Numerous linear or dot-like enhancing foci

○ Converge on single enlarged "collector" vein

○ "Collector" vein drains into dural sinus/deep ependymal

vein

○ Usually solitary, variable size (< 2-3 cm)

○ Hemorrhage may occur if mixed malformation or

draining vein thromboses

• CT often normal; enlarged "collector" vein may appear

hyperdense

• MR

○ Variable signal depending on size, flow; hypointense on

SWI (BOLD effect in draining veins); strong enhancement

TOP DIFFERENTIAL DIAGNOSES

• Mixed vascular malformation (usually cavernoma)

• Vascular neoplasm

• Dural sinus thrombosis (chronic)

PATHOLOGY

• 15-20% coexisting cavernous &/or capillary malformations

• Blue rubber bleb nevus syndrome

• Sulcation-gyration disorders (may cause epilepsy)

• Cervicofacial venous or lymphatic malformation

CLINICAL ISSUES

• Can be asymptomatic or present with headaches &/or

hemorrhage

(Left) Coronal oblique graphic

depicts classic developmental

venous anomaly (DVA) with

umbrella-like "Medusa head"

of enlarged medullary (deep

WM) veins ﬈ converging on a

dilated transcortical

"collector" vein ﬊, which

drains into the superior

sagittal sinus st. (Right) Axial

T1 C+ FS in a 55-year-old man

imaged for headache shows a

large "Medusa head" ſt of a

DVA involving the pons and

cerebellum.

(Left) T2* SWI in the same

case shows multiple linear

hypointensities ﬊ caused by

slow flow, deoxyhemoglobin

in the DVA. The

hypointensities in the

cerebellar fissures ﬉ are

normal peritentorial draining

veins. (Right) 3D shaded

surface rendering of a venousphase DSA in another case

elegantly depicts the classic

"Medusa head" of a DVA ﬇.

(Courtesy P. Lasjaunias, MD.)

Brain: Pathology-Based Diagnoses: Malformations,

Trauma, and Stroke

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