What is the role of physical exam in diagnosis?
Many of these lesions have skin findings or physical exam findings. We learn important things by feeling a vascular lesion and changing the position of patients during an exam. This is a real challenge when we review international cases on Wednesday nights for patients from afar. We can offer a diagnosis in most cases with reasonable certainty, but we would benefit a lot by seeing that patient in person. We often try to get digital photos, and a high resolution digital photo can tell us a fair amount. We have photos in a database on over 12,000 patients that we’ve seen through the years. These are invaluable to compare a patient to his or her own prior photos or to compare across multiple patients.
Cameron Trenor, MD
How are Doppler and ultrasound used in diagnosis?
We use a Doppler probe or an ultrasound to literally hear whether it’s a fast flow lesion or a slow flow lesion. With the Doppler probe, slow flow is relatively quiet, the noise you hear is the probe moving on the skin, whereas fast flow sounds a bit more like a tornado, or a washing machine or a loud pulse. Many of us utilize Doppler as part of our exam of vascular lesions. In our clinic, we have radiologists and a portable ultrasound machine available. Ultrasound is a little bit more precise because you get a picture along with the sound waves. This allows assessment of direction of flow, compressibility of channels, evidence of old blood clots, depth of lesions or involvement of nearby structures, for example.
Cameron Trenor, MD
How is other medical imaging used in diagnosis?
Usually we can come to an answer without a biopsy but if we’re not certain then we may recommend biopsy to reach a diagnosis. We cannot offer valuable management advice if we’re unsure of the diagnosis. We have an outstanding group of radiologists with expertise in vascular anomalies and through them we evaluate many different types of imaging. In addition to CT scans, MRI scans and ultrasounds we also utilize vascular imaging like venograms, angiograms, lymphangiograms, or lymphoscintigraphy, measuring specific vascular beds or specific lymphatic channels. We use a lot of pattern recognition during review of imaging, and we benefit immensely from the volume of cases referred to us.
Cameron Trenor, MD